Provider Demographics
NPI:1700990728
Name:MILLAN-APONTE, ISMENIO (MD)
Entity type:Individual
Prefix:
First Name:ISMENIO
Middle Name:
Last Name:MILLAN-APONTE
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:AVE. ROBERTO CLEMENTE STREET 11 BLOCK 33-2
Mailing Address - Street 2:VILLA CAROLINA,
Mailing Address - City:CAROLINA,
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5436
Mailing Address - Country:US
Mailing Address - Phone:787-769-1630
Mailing Address - Fax:787-769-1630
Practice Address - Street 1:AVE. ROBERTO CLEMENTE STREET 11 BLOCK 33-2
Practice Address - Street 2:VILLA CAROLINA,
Practice Address - City:CAROLINA,
Practice Address - State:PR
Practice Address - Zip Code:00985-5436
Practice Address - Country:US
Practice Address - Phone:787-769-1630
Practice Address - Fax:787-769-1630
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11400207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0084314Medicare ID - Type Unspecified
PRG41620Medicare UPIN