Provider Demographics
NPI:1598710469
Name:MILLENNIUM MEDICAL & TREATMENT CENTER
Entity Type:Organization
Organization Name:MILLENNIUM MEDICAL & TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-924-5474
Mailing Address - Street 1:121 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3733
Mailing Address - Country:US
Mailing Address - Phone:305-924-5474
Mailing Address - Fax:
Practice Address - Street 1:2742 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4636
Practice Address - Country:US
Practice Address - Phone:305-924-5474
Practice Address - Fax:
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 Licenses
StateLicense IDTaxonomies
FL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4960Medicare ID - Type UnspecifiedPROVIDER NUMBER