Healthcare Provider Details

I. General information

NPI: 1083735856
Provider Name (Legal Business Name): ERNESTO J MILLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 N. HABANA AVE. SUITE 1
TAMPA FL
33614-6873
US

IV. Provider business mailing address

5110 N HABANA AVE SUITE 1
TAMPA FL
33614-6873
US

V. Phone/Fax

Practice location:
  • Phone: 813-448-6755
  • Fax: 813-304-2219
Mailing address:
  • Phone: 813-448-6755
  • Fax: 813-304-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME0079748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: