MEDICARE: MILLA PEDIATRICS & ASSOCIATES, INC.

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	208000000X	Pediatrics Physician

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386726578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLA PEDIATRICS & ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	1847 SW BARNETT WAY
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-6957
Country	:	US
Telephone Number	:	386-755-2240
Fax Number	:	386-755-6598

Provider Business Practice Location Address
First Line	:	1847 SW BARNETT WAY
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-6957
Country	:	US
Telephone Number	:	386-755-2240
Fax Number	:	386-755-6598

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAULINO MILLA
Credential	:	MD
Telephone Number	:	386-755-2240

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	01/06/2009

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