Provider Demographics
NPI:1811937048
Name:BASTIANELLI, MILO (DO)
Entity type:Individual
Prefix:DR
First Name:MILO
Middle Name:
Last Name:BASTIANELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13660 S JOG RD STE 3
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3806
Mailing Address - Country:US
Mailing Address - Phone:561-495-2002
Mailing Address - Fax:561-733-3742
Practice Address - Street 1:13660 S JOG RD STE 3
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3806
Practice Address - Country:US
Practice Address - Phone:561-495-2002
Practice Address - Fax:561-733-3742
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06532600207YX0007X, 207X00000X, 207YS0123X
FLOS16264207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ854041OtherAETNA
FLOS162264OtherLICENSE
G53261Medicare UPIN
NJ854041OtherAETNA