Healthcare Provider Details

I. General information

NPI: 1366234056
Provider Name (Legal Business Name): ETERNAL SOLE FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 HIGHWAY 90 STE 230
PACE FL
32571-1098
US

IV. Provider business mailing address

3754 HIGHWAY 90 STE 230
PACE FL
32571-1098
US

V. Phone/Fax

Practice location:
  • Phone: 216-767-6731
  • Fax: 216-767-6731
Mailing address:
  • Phone: 850-299-4345
  • Fax: 850-299-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. HILAREE MILLIRON
Title or Position: PHYSICIAN
Credential: DPM
Phone: 216-767-6731