Basic Information
| Provider Information | |||||||||
| NPI: | 1497119796 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILLENIUM SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 709 BROOKMEADE CT | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454346299 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8614 SHEPHERD FARM DR | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450691128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139429500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2016 | ||||||||
| LastUpdateDate: | 11/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | RAHMAN | ||||||||
| AuthorizedOfficialFirstName: | SHAKIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8457295036 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 3586069 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.