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General NPI Number Information
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NPI Number | 1063185601
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Entity Type | Organization
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Legal Business Name | MILLENNIUM PHYSICIAN GROUP, LLC
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 2002 DEL PRADO BLVD S STE 100
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City | CAPE CORAL
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State | FL
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Zip | 33990-4557
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Country | US
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Telephone | 239-217-4470
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Fax | 239-217-4474
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Provider Business Mailing Address
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Address Line | 2675 WINKLER AVE FL 2
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City | FORT MYERS
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State | FL
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Zip | 33901-9342
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Country | US
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Telephone | 877-856-3774
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Fax |
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Authorized Official
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Title or Position | DIRECTOR REVENUE CYCLE
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Name | MARY HALTIGAN
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Credential |
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Telephone | 877-856-3774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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