Millennium Physician Group LLC
Organization Active NPI Family Medicine Physician · Bonita Springs, FL
NPI 1316319221 · NPPES record last updated Jan 18, 2023
Key facts
- NPI
- 1316319221
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MILLENNIUM PHYSICIAN GROUP LLC
- Practice address
- 9500 Bonita Beach Rd SE Ste 101
Bonita Springs, FL 34135-4679 - Phone
- (239) 498-9294
- Fax
- (239) 498-7179
- NPI assigned
- Oct 30, 2015
- Organization subpart
- No
Authorized official
- Name
- Mary Haltigan
- Title
- Business Operations Manager
- Phone
- (877) 856-3774
Corporate family (same tax ID) 24
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D1026705 | Millennium Physician Group LLC | Certificate of waiver | Jun 13, 2028 |
National Provider Directory
- Tax ID family
- Millennium Physician Group LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
9500 Bonita Beach Rd SE Ste 101
Bonita Springs, FL 34135-4679
Mailing address
2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774
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- Michelle Amendola SLP, LLC
- Michelle Hogan NP Wellness Consultant LLC
- Ann M Mihalko
- Millennium House 2, LLC
- Millennium House of Southwest Florida, Inc
- Millennium Physician Group LLC
- Joel Scott Miller
- Shawn B Miller
- Kendall Millman
- Mind/Mood Counseling & Coaching Centers of SWFL, PLLC
All providers in Bonita Springs, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.