Millennium Physician Group LLC
Family Medicine in Jacksonville, FL. Organization (NPI-2).
NPI number1063189751
StatusActive
Last updated in NPPESJan 18, 2023
Details
- NPI
- 1063189751
- Entity type
- Organization (NPI-2)
- Legal business name
- Millennium Physician Group LLC
- Organization subpart
- No
- Enumeration date
- Aug 30, 2021
- Certification date
- Jan 18, 2023
- Last updated
- Jan 18, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Practice location
8093 Normandy BlvdJacksonville, FL 32221-6646
Phone 904-633-0640 · Fax 904-633-0641
Mailing address
2675 Winkler Ave Fl 2floorFort Myers, FL 33901-9342
Phone 877-856-3774
Authorized official
Mary Haltigan
Director Of Revenue Cycle
8778563774
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