Provider Demographics
NPI:1902855505
Name:MILTENBERGER, CHESTER D (MD)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:D
Last Name:MILTENBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 N SUN DR
Mailing Address - Street 2:SUITE 1060
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2552
Mailing Address - Country:US
Mailing Address - Phone:407-322-5923
Mailing Address - Fax:407-333-2358
Practice Address - Street 1:766 N SUN DR
Practice Address - Street 2:SUITE 1060
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2552
Practice Address - Country:US
Practice Address - Phone:407-322-5923
Practice Address - Fax:407-333-2358
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40263207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202961800Medicaid
FL15731Medicare ID - Type Unspecified
FLD52718Medicare UPIN