Provider Demographics
NPI:1326059007
Name:MILLARES, AVELINO FERMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AVELINO
Middle Name:FERMIN
Last Name:MILLARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-3715
Mailing Address - Country:US
Mailing Address - Phone:941-474-1042
Mailing Address - Fax:941-475-6032
Practice Address - Street 1:356 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223
Practice Address - Country:US
Practice Address - Phone:941-474-1042
Practice Address - Fax:941-475-6032
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065947207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F90050Medicare UPIN
FL26175Medicare ID - Type Unspecified
FL377381700Medicaid