Basic Information
| Provider Information | |||||||||
| NPI: | 1639161961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLET | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 N CEDAR CREST BLVD STE 411 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109691917 | ||||||||
| FaxNumber: | 4846647659 | ||||||||
| Practice Location | |||||||||
| Address1: | 2597 SCHOENERSVILLE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104023560 | ||||||||
| FaxNumber: | 6104023355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 11/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD052847L | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 0734803000 | 01 | PA | KEYSTONE EAST | OTHER | 32210 | 01 | PA | GEISINGER | OTHER | 0014818100001 | 05 | PA | MEDICAID | 531751 | 01 | PA | KEYSTONE CENTRAL | OTHER | P3626762 | 01 | PA | OXFORD | OTHER | 50048433 | 01 | PA | KEYSTONE CENTRAL | OTHER | 5248008 | 01 | PA | AETNA | OTHER | 531751 | 01 | PA | AMERIHEALTH ADMIN | OTHER | 821049 | 01 | PA | FIRST PRIORITY HEALTH | OTHER | 50048433 | 01 | PA | BLUE CROSS | OTHER | 531751 | 01 | PA | BLUE SHIELD | OTHER |