Provider Demographics
NPI:1518328301
Name:DOCTORS INLET PEDIATRICS AND PRIMARY CARE
Entity Type:Organization
Organization Name:DOCTORS INLET PEDIATRICS AND PRIMARY CARE
Other - Org Name:DOCTORS INLET INTERNAL MEDICINE, SPINE AND PAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILIND
Authorized Official - Middle Name:V
Authorized Official - Last Name:TILAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-298-1994
Mailing Address - Street 1:430 COLLEGE DRIVE
Mailing Address - Street 2:SUITE 100/102
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8531
Mailing Address - Country:US
Mailing Address - Phone:904-644-8669
Mailing Address - Fax:904-298-1994
Practice Address - Street 1:430 COLLEGE DR STE 100-102-104-106
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068
Practice Address - Country:US
Practice Address - Phone:904-298-1994
Practice Address - Fax:904-298-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty