Provider Demographics
NPI:1033651799
Name:MILELLA, IGNAZIO
Entity Type:Individual
Prefix:
First Name:IGNAZIO
Middle Name:
Last Name:MILELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 FAIRLAKE TRCE
Mailing Address - Street 2:APT 503
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2872
Mailing Address - Country:US
Mailing Address - Phone:754-715-7966
Mailing Address - Fax:
Practice Address - Street 1:1235 FAIRLAKE TRCE
Practice Address - Street 2:APT 503
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2872
Practice Address - Country:US
Practice Address - Phone:754-715-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-12
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16-478246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant