Provider Demographics
NPI:1184014276
Name:ELIAS MILGRAM M.D. L.L.C.
Entity Type:Organization
Organization Name:ELIAS MILGRAM M.D. L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MILGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-490-8690
Mailing Address - Street 1:2875 NE 191ST ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2801
Mailing Address - Country:US
Mailing Address - Phone:305-932-3083
Mailing Address - Fax:
Practice Address - Street 1:2875 NE 191ST ST
Practice Address - Street 2:SUITE 604
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2801
Practice Address - Country:US
Practice Address - Phone:305-932-3083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81124261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264396100Medicaid
11340235OtherCAQH
BM7022875OtherD.E.A.
93507690023OtherAMA EDUC#
FL264396100Medicaid