Provider Demographics
NPI:1376876318
Name:CHESTER D. MILTENBERGER, MD PA
Entity Type:Organization
Organization Name:CHESTER D. MILTENBERGER, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILTENBERGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:407-322-5923
Mailing Address - Street 1:766 N SUN DR
Mailing Address - Street 2:SUITE 1060
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2552
Mailing Address - Country:US
Mailing Address - Phone:407-322-5923
Mailing Address - Fax:407-333-2358
Practice Address - Street 1:766 N SUN DR
Practice Address - Street 2:SUITE 1060
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2552
Practice Address - Country:US
Practice Address - Phone:407-322-5923
Practice Address - Fax:407-333-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40263207R00000X
FLME0040263209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202961800Medicaid
FL1902855505OtherINDIVIDUAL PROVIDER NPI
FL15732Medicare PIN
FL1902855505OtherINDIVIDUAL PROVIDER NPI
FL15731Medicare PIN