# MILLENNIUM PHYSICIAN GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528721511
- **Authorized official:** MARY HALTIGAN (DIRECTOR OF REVENUE CYCLE)
- **Authorized official phone:** (877) 856-3774

## Contact information

- **Practice address:** 1201 MONUMENT RD STE 200, JACKSONVILLE, FL 32225-7428
- **Practice address phone:** (904) 727-5151
- **Practice address fax:** (904) 727-5180
- **Mailing address:** 2675 WINKLER AVE FL 2, FORT MYERS, FL 33901-9342
- **Mailing address phone:** (877) 856-3774
- **Mailing address fax:** (239) 599-2612

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/18/2021
- **Last updated:** 01/18/2023