Healthcare Provider Details

I. General information

NPI: 1902855505
Provider Name (Legal Business Name): CHESTER D. MILTENBERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 N SUN DR SUITE 1060
LAKE MARY FL
32746-2552
US

IV. Provider business mailing address

766 N SUN DR SUITE 1060
LAKE MARY FL
32746-2552
US

V. Phone/Fax

Practice location:
  • Phone: 407-322-5923
  • Fax: 407-333-2358
Mailing address:
  • Phone: 407-322-5923
  • Fax: 407-333-2358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME40263
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME40263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: