Provider Demographics
NPI:1730638842
Name:MILESTONES WELLNESS CENTERS
Entity Type:Organization
Organization Name:MILESTONES WELLNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVACS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-931-0907
Mailing Address - Street 1:3900 BROADWAY
Mailing Address - Street 2:STE 7
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8193
Mailing Address - Country:US
Mailing Address - Phone:239-931-0907
Mailing Address - Fax:239-309-0330
Practice Address - Street 1:3900 BROADWAY
Practice Address - Street 2:STE 7
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8193
Practice Address - Country:US
Practice Address - Phone:239-931-0907
Practice Address - Fax:239-309-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS1417207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBUS2016-00728OtherFLORIDA TAX PERMIT