MEDICARE: CHESTER D. MILTENBERGER, MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	209800000X	Legal Medicine (M.D./D.O.) Physician	ME0040263	FL
2	207R00000X	Internal Medicine Physician	ME40263	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1902855505	OTHER	FL	INDIVIDUAL PROVIDER NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376876318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESTER D. MILTENBERGER, MD PA

Provider Business Mailing Address
First Line	:	766 N SUN DR
Second Line	:	SUITE 1060
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2552
Country	:	US
Telephone Number	:	407-322-5923
Fax Number	:	407-333-2358

Provider Business Practice Location Address
First Line	:	766 N SUN DR
Second Line	:	SUITE 1060
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2552
Country	:	US
Telephone Number	:	407-322-5923
Fax Number	:	407-333-2358

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. CHESTER D MILTENBERGER JR.
Credential	:	MD
Telephone Number	:	407-322-5923

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	08/23/2010

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