MEDICARE: MILLENNIUM PHYSICIAN GROUP LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1114699790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM PHYSICIAN GROUP LLC

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2612

Provider Business Practice Location Address
First Line	:	4265 LAURA ST
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-2836
Country	:	US
Telephone Number	:	941-764-7117
Fax Number	:	941-764-1049

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE CYCLE
Name	:	MARY HALTIGAN
Credential	:
Telephone Number	:	877-856-3774

Provider Enumeration Date	:	10/01/2021
Last Update Date	:	01/18/2023

Similar Medicare Providers

1174520910 — ADVANCED REHABILITATION MEDICAL SERVICES
Practice Location Address:

4265 LAURA ST
PORT CHARLOTTE, FL
33980-2836

Practice Phone: 941-764-7117
Practice Fax: 941-764-1049

1235017500 — ELLIE'S WORLD PPEC, LLC
Practice Location Address:

4265 LAURA ST
PORT CHARLOTTE, FL
33980-2836

Practice Phone: 786-352-2850
Practice Fax:

1083175418 — GENE THOMAS DRISKILL I PTA
Practice Location Address:

5750 ILLINOIS AVE
NEW PORT RICHEY, FL
34652-2836

Practice Phone: 865-556-2317
Practice Fax:

1336098367 — MYYA SINGLETARY
Practice Location Address:

447 S SHARON AMITY RD
CHARLOTTE, NC
28211-2836

Practice Phone: 704-264-2973
Practice Fax:

1588644561 — DR. FRANKLIN MARCUS DUNN D.C.
Practice Location Address:

447 S SHARON AMITY RD , SUITE 210
CHARLOTTE, NC
28211-2836

Practice Phone: 704-964-5496
Practice Fax:

1124047782 — DENISE O. KINSER LCSW
Practice Location Address:

447 S SHARON AMITY RD STE 200
CHARLOTTE, NC
28211-2836

Practice Phone: 704-281-5178
Practice Fax:

Directions to “MILLENNIUM PHYSICIAN GROUP LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.