Provider Demographics
NPI:1629719687
Name:MILIEN, LUNEL
Entity Type:Individual
Prefix:
First Name:LUNEL
Middle Name:
Last Name:MILIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 N 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-4563
Mailing Address - Country:US
Mailing Address - Phone:305-321-0543
Mailing Address - Fax:
Practice Address - Street 1:1511 PROSPERITY FARMS RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2046
Practice Address - Country:US
Practice Address - Phone:561-847-4794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015270363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner