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NPI Code Detail

MEDICARE: MINERVA MILAGRO ELLIS D.O.

MEDICARE: MINERVA MILAGRO ELLIS D.O.
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
1207R00000XInternal Medicine PhysicianOS11360FL

General Provider Information

NPI Number : 1457687691
Entity Type Code : Individual
Provider Name (Legal Business Name) : MINERVA MILAGRO ELLIS D.O.
Provider Business Mailing Address
First Line : 4601 N CONGRESS AVE
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33407-3228
Country : US
Telephone Number : 561-840-4620
Fax Number : 561-840-4680
Provider Business Practice Location Address
First Line : 4601 N CONGRESS AVE
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33407-3228
Country : US
Telephone Number : 561-840-4620
Fax Number : 561-840-4680
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2009
Last Update Date : 05/14/2026

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Directions to “ MINERVA MILAGRO ELLIS D.O.” Practice Location

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