MEDICARE: MILA FAMILY HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1093497026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILA FAMILY HEALTH

Provider Business Mailing Address
First Line	:	2728 TRAVIS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-3233
Country	:	US
Telephone Number	:	817-381-8259
Fax Number	:

Provider Business Practice Location Address
First Line	:	2728 TRAVIS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-3233
Country	:	US
Telephone Number	:	414-324-0401
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANATOLI BEREZOVSKY
Credential	:	MD
Telephone Number	:	817-381-8259

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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