Provider Demographics
NPI:1689842460
Name:NEW MILLENNIUM FAMILY MEDICINE P C
Entity Type:Organization
Organization Name:NEW MILLENNIUM FAMILY MEDICINE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:RENATE
Authorized Official - Last Name:MERZENICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-899-5530
Mailing Address - Street 1:655 S DOBSON RD
Mailing Address - Street 2:STE. B216
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5667
Mailing Address - Country:US
Mailing Address - Phone:480-899-5530
Mailing Address - Fax:480-899-4295
Practice Address - Street 1:655 S DOBSON RD
Practice Address - Street 2:STE. B216
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5667
Practice Address - Country:US
Practice Address - Phone:480-899-5530
Practice Address - Fax:480-899-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ555477Medicaid