NPIMap

Organization Active NPI

Millennium Physician Group LLC

  • Family Medicine Physician
  • Bonita Springs, FL
National Provider Identifier
1316319221
Registry record updated Jan 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 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
Last updated
Jan 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Haltigan
Title
Business Operations Manager
Phone
(877) 856-3774

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Family Medicine Physician 207Q00000X Primary

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1026705Millennium Physician Group LLC9500 Bonita Beach Road Suite 101, Bonita Springs, FL 34135Certificate of waiverJun 13, 2028

National Provider Directory

National Provider Directory
Tax ID family
Millennium Physician Group LLC123 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

3434 Hancock Bridge Pkwy
Ste 301
North Ft Myers, FL 33903
Phone 877856377411108

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674000000000",
    "number": "1316319221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774",
            "fax_number": "239-599-2612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 BONITA BEACH RD SE STE 101",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341354679",
            "telephone_number": "239-498-9294",
            "fax_number": "239-498-7179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLENNIUM PHYSICIAN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-30",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A",
        "authorized_official_last_name": "HALTIGAN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "BUSINESS OPERATIONS MANAGER",
        "authorized_official_telephone_number": "877-856-3774"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonita Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.