=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184014276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIAS MILGRAM M.D. L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2015
-----------------------------------------------------
Last Update Date | 01/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2875 NE 191ST ST SUITE 604
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-932-3083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2875 NE 191ST ST SUITE 604
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-932-3083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ELIAS MILGRAM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-490-8690
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | ME81124
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------