Provider Demographics
NPI:1316960735
Name:TILAK, MILIND V (MD)
Entity type:Individual
Prefix:DR
First Name:MILIND
Middle Name:V
Last Name:TILAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MEL
Other - Middle Name:V
Other - Last Name:TILAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:430 COLLEGE DR STE 104-106
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8530
Mailing Address - Country:US
Mailing Address - Phone:904-298-1994
Mailing Address - Fax:904-298-1973
Practice Address - Street 1:430 COLLEGE DR
Practice Address - Street 2:STE 100-102-104-106
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8530
Practice Address - Country:US
Practice Address - Phone:904-298-1994
Practice Address - Fax:904-298-1973
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0282208VP0014X
FLME72684208VP0014X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000105527OtherHUMANA
FL238067OtherAVMED
FL252593300Medicaid
FL41487OtherBCBS
FL7995408OtherAETNA
FLK6020OtherMEDICARE GROUP
FL41487WMedicare PIN