Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 25MB06532600 | NJ |
N | 207YS0123X | Facial Plastic Surgeon | 25MB06532600 | NJ |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 25MB06532600 | NJ |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | OS16264 | FL |
NPI | 1811937048 |
---|---|
Provider Name | Dr. Milo Bastianelli |
First Address | Delray Beach, FL 33446-3806 |
Second Address | Delray Beach, FL 33446-3806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 17/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
854041 | AETNA (01) | NJ |
G53261 | (02) | |
OS162264 | LICENSE (01) | FL |