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Millennium Physician Group LLC

Organization Active NPI Family Medicine Physician · Fort Myers, FL

NPI 1316619182 · NPPES record last updated Jan 18, 2023

Key facts

NPI
1316619182
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
MILLENNIUM PHYSICIAN GROUP LLC
Practice address
4881 Palm Beach Blvd Ste 100
Fort Myers, FL 33905-3217
Phone
(239) 693-9191
Fax
(239) 693-7369
NPI assigned
Sep 30, 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
10D0896969Millennium Physician Group LLC
4881 Palm Beach Blvd Ste 100, Fort Myers, FL 33905		Certificate of waiverOct 22, 2027

National Provider Directory

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

Specialties & licenses

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

Addresses

Primary practice location

4881 Palm Beach Blvd Ste 100
Fort Myers, FL 33905-3217

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.