Provider Demographics
NPI:1982974580
Name:CHESTER D. MILTENBERGER, MD, PA
Entity Type:Organization
Organization Name:CHESTER D. MILTENBERGER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:MILTENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-322-5923
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:766 N SUN DR
Practice Address - Street 2:STE 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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESTER D. MILTENBERGER, MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site