Provider Demographics
NPI:1821348616
Name:MIL-LAKE MEDICAL TWO, PA
Entity Type:Organization
Organization Name:MIL-LAKE MEDICAL TWO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
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 1:2401 QUANTUM BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8612
Mailing Address - Country:US
Mailing Address - Phone:561-739-9333
Mailing Address - Fax:561-739-9911
Practice Address - Street 1:2401 QUANTUM BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8612
Practice Address - Country:US
Practice Address - Phone:561-739-9333
Practice Address - Fax:561-739-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care