Healthcare Provider Details

I. General information

NPI: 1265416754
Provider Name (Legal Business Name): MIL-LAKE HEALTHCARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 LAKE WORTH ROAD
GREENACRES FL
33463
US

IV. Provider business mailing address

4849 LAKE WORTH ROAD
GREENACRES FL
33463
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-4446
  • Fax: 561-433-3026
Mailing address:
  • Phone: 561-433-4446
  • Fax: 561-433-3026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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