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MILLENNIUM PHYSICIAN GROUP LLC
NPI 1629731609
Family Medicine in Fort Myers, FL

Active since October 18, 2021CLIA 10D0979077 · Waiver
14350 METROPOLIS AVE STE 1, FORT MYERS, FL 33912(239) 275-3036(239) 275-8480 Get Directions Write a Review

NPPES record last updated: January 19, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 19, 2023, Oct 18, 2021 (2 updates tracked since 2021).

About Millennium Physician Group Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MILLENNIUM PHYSICIAN GROUP LLC (NPI 1629731609) is a healthcare organization registered as a family medicine in Fort Myers, Florida and active in the NPI registry since October 2021. The organization holds a CLIA Waiver certificate valid through October 11, 2026 and lists Mary Haltigan, Director Of Revenue Cycle, as its authorized official.

NPPES Registry Identity

NPI1629731609
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameMILLENNIUM PHYSICIAN GROUP LLC
Location Address14350 METROPOLIS AVE STE 1Fort Myers, FL 33912-4430
Mailing Address2675 Winkler Ave Fl 2Fort Myers, FL 33901-9342 · (877) 856-3774 · Fax (239) 599-2612
Phone(239) 275-3036
Fax(239) 275-8480
Organization SubpartNo
Authorized OfficialMary HaltiganDirector Of Revenue Cycle · (877) 856-3774
Enumeration DateOctober 18, 2021
Last NPPES UpdateJanuary 19, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 19, 2023
✔ NPI 1629731609 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
14350 METROPOLIS AVE STE 1, Fort Myers, FL 33912
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D0979077

Millennium Physician Group, LLC · Fort Myers, FL
Active · expires Oct 11, 2026
CLIA Number10D0979077
Laboratory TypePhysician Office
Certificate Effective DateOctober 12, 2024
Certificate Expiration DateOctober 11, 2026
Laboratory DirectorGlenn A. Tovar Dias
Laboratory Phone(239) 275-3036
Laboratory LocationMillennium Physician Group, LLC14350 Metropolis Ave Ste 1, Fort Myers, FL 33912
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. PRISCILLA MUTHONI NDIANGUI APRN
Nurse Practitioner (Family)
14350 METROPOLIS AVE STE 1
FORT MYERS, FL 33912
Lee County (239) 275-3036
KRISTEN NEAGLE APRN
Nurse Practitioner (Family)
14350 METROPOLIS AVE STE 1
FORT MYERS, FL 33912
Lee County (239) 275-3036
DR. GLENN A TOVAR DIAS MD
Internal Medicine
14350 METROPOLIS AVE STE 1
FORT MYERS, FL 33912
Lee County (239) 275-3036
BARBARA C BUSTILLO-LEWIN PAC
Physician Assistant
14350 METROPOLIS AVE STE 1
FORT MYERS, FL 33912
Lee County (239) 275-3036

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Millennium Physician Group LLC's NPI number?

The NPI number for Millennium Physician Group LLC is 1629731609. It was assigned to this organization in the NPPES registry on October 18, 2021.

Where is Millennium Physician Group LLC located?

Millennium Physician Group LLC is located at 14350 Metropolis Ave Ste 1, Fort Myers, FL 33912. The listed phone number is (239) 275-3036.

What is Millennium Physician Group LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Millennium Physician Group LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D0979077) is associated with this NPI, valid through October 11, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Millennium Physician Group LLC accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Millennium Physician Group LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Millennium Physician Group LLC was last updated on January 19, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.