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General NPI Number Information
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NPI Number | 1093497026
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Entity Type | Organization
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Legal Business Name | MILA FAMILY HEALTH
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Dates
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Enumeration Date | 08/01/2023
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 2728 TRAVIS AVE
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City | FORT WORTH
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State | TX
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Zip | 76110-3233
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Country | US
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Telephone | 414-324-0401
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Fax |
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Provider Business Mailing Address
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Address Line | 2728 TRAVIS AVE
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City | FORT WORTH
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State | TX
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Zip | 76110-3233
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Country | US
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Telephone | 817-381-8259
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANATOLI BEREZOVSKY
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Credential | MD
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Telephone | 817-381-8259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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