Organization
MILLENNIUM PHYSICIAN GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY HALTIGAN (DIRECTOR REVENUE CYCLE MNGMT)
(877) 856-3774
Entity
Organization
Contact information
Practice address
2450 TAMIAMI TRL STE A, PORT CHARLOTTE, FL 33952-3922
(941) 624-2704
(941) 627-6066
Mailing address
2675 WINKLER AVE FL 2, FORT MYERS, FL 33901-9342
(877) 856-3774
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6953950003
MEDICARE NSC
FL
Enumeration date
09/24/2013
Last updated
01/18/2023
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