Provider Demographics
NPI:1508346263
Name:MILENNIUM MEDICAL LTD
Entity Type:Organization
Organization Name:MILENNIUM MEDICAL LTD
Other - Org Name:MILENNIUM MEDICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BESTERFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:773-614-3302
Mailing Address - Street 1:2033 N MILWAUKEE AVE
Mailing Address - Street 2:UNIT 325
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-0325
Mailing Address - Country:US
Mailing Address - Phone:773-614-3302
Mailing Address - Fax:847-906-1092
Practice Address - Street 1:2866 FALLING WATERS
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046
Practice Address - Country:US
Practice Address - Phone:773-614-3302
Practice Address - Fax:847-906-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013714363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty