Provider Demographics
NPI:1376597203
Name:MILLENIUM CONSULTANT MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:MILLENIUM CONSULTANT MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-456-3742
Mailing Address - Street 1:1920 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:905
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4722
Mailing Address - Country:US
Mailing Address - Phone:954-456-3742
Mailing Address - Fax:954-456-3752
Practice Address - Street 1:1920 E HALLANDALE BEACH BLVD
Practice Address - Street 2:905
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4722
Practice Address - Country:US
Practice Address - Phone:954-456-3742
Practice Address - Fax:954-456-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty