Healthcare Provider Details

I. General information

NPI: 1821348616
Provider Name (Legal Business Name): MIL-LAKE MEDICAL TWO, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 QUANTUM BLVD
BOYNTON BEACH FL
33426-8612
US

IV. Provider business mailing address

2401 QUANTUM BLVD
BOYNTON BEACH FL
33426-8612
US

V. Phone/Fax

Practice location:
  • Phone: 561-739-9333
  • Fax: 561-739-9911
Mailing address:
  • Phone: 561-739-9333
  • Fax: 561-739-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID ABELLARD
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 561-433-4446