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General NPI Number Information
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NPI Number | 1740460211
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Entity Type | Organization
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Legal Business Name | MILLENNIUM MEDICAL P C
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 1153 E GANNON DR
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City | FESTUS
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State | MO
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Zip | 63028-2611
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Country | US
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Telephone | 636-931-3667
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Fax |
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Provider Business Mailing Address
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Address Line | 1153 E GANNON DR
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City | FESTUS
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State | MO
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Zip | 63028-2611
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Country | US
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Telephone | 636-931-3667
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SOLOMON NOGUERA
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Credential | M.D.
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Telephone | 636-931-3667
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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 | R8H32
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License Number State | MO
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