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General NPI Number Information
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NPI Number | 1366645376
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Entity Type | Organization
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Legal Business Name | MILLENNIUM MEDICAL MANAGEMENT LLC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 7955 SPYGLASS HILL RD STE A
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City | MELBOURNE
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State | FL
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Zip | 32940-8249
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Country | US
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Telephone | 321-255-6670
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Fax | 321-242-2545
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Provider Business Mailing Address
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Address Line | 7955 SPYGLASS HILL RD STE A
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City | MELBOURNE
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State | FL
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Zip | 32940-8249
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Country | US
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Telephone | 321-255-6670
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Fax | 321-242-2545
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Authorized Official
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Title or Position | FINANCIAL OFFICER
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Name | SUN MEE DEUKMEDJIAN
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Credential |
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Telephone | 321-775-1290
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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 | ME84856
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME95180
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | ME95180
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME93866
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME111580
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | OS12589
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License Number State | FL
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Taxonomy #7
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME93866
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License Number State | FL
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Taxonomy #8
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME111580
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License Number State | FL
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Taxonomy #9
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | OS12589
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License Number State | FL
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Taxonomy #10
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME93866
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License Number State | FL
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Taxonomy #11
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME93866
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License Number State | FL
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Taxonomy #12
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME111580
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License Number State | FL
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Taxonomy #13
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number | IAC ACCREDITED 7422
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License Number State | FL
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Taxonomy #14
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9105911
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License Number State | FL
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Taxonomy #15
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | ME82061
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License Number State | FL
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