Healthcare Provider Details

I. General information

NPI: 1285741322
Provider Name (Legal Business Name): MILLENNIUM ANESTHESIA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 NW 107TH TERRACE
SUNRISE FL
33322-3418
US

IV. Provider business mailing address

PO BOX 198106
ATLANTA GA
30384-8106
US

V. Phone/Fax

Practice location:
  • Phone: 954-741-0636
  • Fax:
Mailing address:
  • Phone: 954-741-0636
  • Fax: 352-732-6282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY HINDIN
Title or Position: PRESIDENT
Credential: MD
Phone: 954-741-0636