Provider Demographics
NPI:1649412958
Name:DAVID MILBAUER MD PA
Entity Type:Organization
Organization Name:DAVID MILBAUER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-642-2800
Mailing Address - Street 1:6894 LAKE WORTH RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2964
Mailing Address - Country:US
Mailing Address - Phone:561-642-2800
Mailing Address - Fax:561-963-1955
Practice Address - Street 1:6894 LAKE WORTH RD STE 104
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467
Practice Address - Country:US
Practice Address - Phone:561-642-2800
Practice Address - Fax:561-963-1955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066699207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376101100Medicaid
FL25536Medicare PIN
FLF87013Medicare UPIN