Provider Demographics
NPI:1811011539
Name:MILO, LENNY MATHEW
Entity Type:Individual
Prefix:
First Name:LENNY
Middle Name:MATHEW
Last Name:MILO
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 1:3031 N OCEAN BLVD
Mailing Address - Street 2:#808
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7334
Mailing Address - Country:US
Mailing Address - Phone:954-565-5043
Mailing Address - Fax:
Practice Address - Street 1:4720 N. STATE RD.7
Practice Address - Street 2:
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-730-7284
Practice Address - Fax:954-497-3857
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator