Healthcare Provider Details

I. General information

NPI: 1851638167
Provider Name (Legal Business Name): ERNESTO J. MILLAN MD. PA.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
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:
Mailing address:
  • Phone: 813-448-6755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ERNESTO JOSE MILLAN
Title or Position: OWNER
Credential: M.D.
Phone: 813-448-6755