Healthcare Provider Details

I. General information

NPI: 1073832812
Provider Name (Legal Business Name): MILLENNIUM PHYSICIAN GROUP OF NC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BEN FRANKLIN BLVD
DURHAM NC
27704-2143
US

IV. Provider business mailing address

2675 WINKLER AVE STE 200
FORT MYERS FL
33901-9328
US

V. Phone/Fax

Practice location:
  • Phone: 919-477-6900
  • Fax: 919-620-0974
Mailing address:
  • Phone: 877-856-3774
  • Fax: 395-992-6122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY HALTIGAN
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 877-856-3774