1164486957 NPI number — DR ADOLFO N MILLAN PA

Table of content: MR. EDWARD EARL NEWBY II (NPI 1225499882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164486957 NPI number — DR ADOLFO N MILLAN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR ADOLFO N MILLAN PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164486957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5601 CORPORATE WAY
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-478-7422
Provider Business Mailing Address Fax Number:
561-478-2377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5601 CORPORATE WAY
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-478-7422
Provider Business Practice Location Address Fax Number:
561-478-2377
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLAN
Authorized Official First Name:
ADOLFO
Authorized Official Middle Name:
NAVARRO
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
561-478-7422

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME0026226 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 263374400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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