Provider Demographics
NPI:1760842041
Name:MILLAKE HEALTHCARE OF LAUDERHILL
Entity Type:Organization
Organization Name:MILLAKE HEALTHCARE OF LAUDERHILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ABELLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-433-4446
Mailing Address - Street 1:7200 W COMMERCIAL BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2148
Mailing Address - Country:US
Mailing Address - Phone:954-748-6665
Mailing Address - Fax:954-746-0310
Practice Address - Street 1:7200 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2148
Practice Address - Country:US
Practice Address - Phone:954-748-6665
Practice Address - Fax:954-746-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061341000Medicaid
FL061341000Medicaid