Provider Demographics
NPI:1093497026
Name:MILA FAMILY HEALTH
Entity Type:Organization
Organization Name:MILA FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANATOLI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEREZOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-381-8259
Mailing Address - Street 1:2728 TRAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-3233
Mailing Address - Country:US
Mailing Address - Phone:817-381-8259
Mailing Address - Fax:
Practice Address - Street 1:2728 TRAVIS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-3233
Practice Address - Country:US
Practice Address - Phone:414-324-0401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care