Provider Demographics
NPI:1477634244
Name:MILLENIUM MEDICAL GROUP, CORP.
Entity Type:Organization
Organization Name:MILLENIUM MEDICAL GROUP, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUFRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-262-5262
Mailing Address - Street 1:7360 CORAL WAY STE 22A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1482
Mailing Address - Country:US
Mailing Address - Phone:305-262-5262
Mailing Address - Fax:305-262-1229
Practice Address - Street 1:7360 CORAL WAY STE 22A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1482
Practice Address - Country:US
Practice Address - Phone:305-262-5262
Practice Address - Fax:305-262-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5642251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health