Healthcare Provider Details

I. General information

NPI: 1518980937
Provider Name (Legal Business Name): DOCTORS INLET PEDIATRICS & PRIMARY CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 COLLEGE DR STE 104-106
MIDDLEBURG FL
32068-8530
US

IV. Provider business mailing address

430 COLLEGE DR STE 104-106
MIDDLEBURG FL
32068-8530
US

V. Phone/Fax

Practice location:
  • Phone: 904-298-1994
  • Fax: 904-298-1973
Mailing address:
  • Phone: 904-298-1994
  • Fax: 904-298-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MILIND V TILAK
Title or Position: PHYSICIAN
Credential:
Phone: 904-298-1994