Provider Demographics
NPI:1871218313
Name:MILLIE MEDICAL OF DELAWARE, P.A.
Entity type:Organization
Organization Name:MILLIE MEDICAL OF DELAWARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER NETWORK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-619-8285
Mailing Address - Street 1:222 LAKEVIEW AVE STE 735
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-6145
Mailing Address - Country:US
Mailing Address - Phone:231-432-5841
Mailing Address - Fax:
Practice Address - Street 1:1521 CONCORD PIKE STE 301-10
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3642
Practice Address - Country:US
Practice Address - Phone:561-476-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty