Provider Demographics
NPI:1235462193
Name:MILLENNIUM OPTIMUM CARE, LLC
Entity Type:Organization
Organization Name:MILLENNIUM OPTIMUM CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:O
Authorized Official - Last Name:BANKOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-787-8371
Mailing Address - Street 1:603 LANSING AVENUE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3209
Mailing Address - Country:US
Mailing Address - Phone:517-787-8371
Mailing Address - Fax:517-787-2639
Practice Address - Street 1:603 LANSING AVENUE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3209
Practice Address - Country:US
Practice Address - Phone:517-787-8371
Practice Address - Fax:517-787-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic