Provider Demographics
NPI:1285799940
Name:MILGRAM, ELIAS (MD)
Entity type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:
Last Name:MILGRAM
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 1:20200 W DIXIE HWAY STE 903
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:305-932-3083
Mailing Address - Fax:305-890-2746
Practice Address - Street 1:20200 W. DIXIE HWAY STE 903
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-932-3083
Practice Address - Fax:305-890-2746
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 81124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2643961 00Medicaid
FL11340235OtherCAHQ PROVIDER#
FL1184014276OtherCDRP.
93507690023OtherAMA EDUCAT #
93507690023OtherAMA EDUCAT #