Healthcare Provider Details

I. General information

NPI: 1700990728
Provider Name (Legal Business Name): ISMENIO MILLAN-APONTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. ROBERTO CLEMENTE STREET 11 BLOCK 33-2 VILLA CAROLINA,
CAROLINA PR
00985-5436
US

IV. Provider business mailing address

AVE. ROBERTO CLEMENTE STREET 11 BLOCK 33-2 VILLA CAROLINA,
CAROLINA PR
00985-5436
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-1630
  • Fax: 787-769-1630
Mailing address:
  • Phone: 787-769-1630
  • Fax: 787-769-1630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number11400
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: