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General NPI Number Information
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NPI Number | 1972234417
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Entity Type | Organization
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Legal Business Name | MILLENNIUM PROVIDER GROUP, P.A.
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 6321 DANIELS PKWY STE 200
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City | FORT MYERS
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State | FL
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Zip | 33912-4773
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Country | US
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Telephone | 855-674-7400
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Fax | 855-674-7401
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Provider Business Mailing Address
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Address Line | 6321 DANIELS PKWY STE 200
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City | FORT MYERS
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State | FL
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Zip | 33912-4773
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Country | US
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Telephone | 855-674-7400
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Fax | 855-674-7401
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Authorized Official
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Title or Position | MARKET PRESIDENT
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Name | CHASITY CHASE
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Credential |
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Telephone | 855-674-7400
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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 |
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License Number State |
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