MEDICARE: DR. CHESTER D. MILTENBERGER M.D.

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	207R00000X	Internal Medicine Physician	ME40263	FL
2	174400000X	Specialist	ME40263	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902855505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHESTER D. MILTENBERGER M.D.

Provider Business Mailing Address
First Line	:	766 N SUN DR
Second Line	:	SUITE 1060
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2552
Country	:	US
Telephone Number	:	407-322-5923
Fax Number	:	407-333-2358

Provider Business Practice Location Address
First Line	:	766 N SUN DR
Second Line	:	SUITE 1060
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2552
Country	:	US
Telephone Number	:	407-322-5923
Fax Number	:	407-333-2358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	01/27/2023

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