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Millennium Physician Group LLC

Organization Active NPI Family Medicine Physician · Fort Myers, FL

NPI 1275296162 · NPPES record last updated Jan 18, 2023

Key facts

NPI
1275296162
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
MILLENNIUM PHYSICIAN GROUP LLC
Practice address
13774 Plantation Rd Ste 100
Fort Myers, FL 33912-4461
Phone
(239) 236-7777
Fax
(239) 245-7028
NPI assigned
Oct 18, 2021
Organization subpart
No

Authorized official

Name
Mary Haltigan
Title
Director of Revenue Cycle
Phone
(877) 856-3774

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2004922Millennium Physician Group LLC
13774 Plantation Road Unit 101, Fort Myers, FL 33912		Certificate of waiverMar 15, 2028

National Provider Directory

Tax ID family
Millennium Physician Group LLC (123 organizations share this tax ID)

Locations

13774 Plantation Rd
Ste 100
Fort Myers, FL 33912
Phone (239) 236-7777

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

13774 Plantation Rd Ste 100
Fort Myers, FL 33912-4461

Mailing address

2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774

Other providers in Fort Myers, FL

All providers in Fort Myers, FL · Family Medicine Physician in Florida

Sources for this page

Verify at the official NPI Registry.