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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1982974580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESTER D. MILTENBERGER, MD, PA

Provider Business Mailing Address
First Line	:	2980 N BEVERLY GLEN CIR
Second Line	:	SUITE 301
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1726
Country	:	US
Telephone Number	:	310-474-9809
Fax Number	:

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

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. CHESTER MILTENBERGER
Credential	:	M.D.
Telephone Number	:	407-322-5923

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	01/12/2012

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