Healthcare Provider Details

I. General information

NPI: 1033651799
Provider Name (Legal Business Name): IGNAZIO MILELLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2016
Last Update Date: 11/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 FAIRLAKE TRCE APT 503
WESTON FL
33326-2872
US

IV. Provider business mailing address

1235 FAIRLAKE TRCE APT 503
WESTON FL
33326-2872
US

V. Phone/Fax

Practice location:
  • Phone: 754-715-7966
  • Fax:
Mailing address:
  • Phone: 754-715-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number16-478
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: