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General NPI Number Information
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NPI Number | 1811937048
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Entity Type | Individual
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Provider Name | MILO BASTIANELLI DO
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 13660 S JOG RD STE 3
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City | DELRAY BEACH
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State | FL
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Zip | 33446-3806
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Country | US
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Telephone | 561-495-2002
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Fax | 561-733-3742
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Provider Business Mailing Address
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Address Line | 13660 S JOG RD STE 3
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City | DELRAY BEACH
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State | FL
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Zip | 33446-3806
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Country | US
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Telephone | 561-495-2002
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Fax | 561-733-3742
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 25MB06532600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | OS16264
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 25MB06532600
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 25MB06532600
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License Number State | NJ
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