MEDICARE: DR. JARRED EVAN MAIT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208D00000X	General Practice Physician	ME 124911	FL

General Provider Information

NPI Number	:	1043553563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARRED EVAN MAIT M.D.

Provider Business Mailing Address
First Line	:	925 W 41ST ST STE 300
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3339
Country	:	US
Telephone Number	:	954-993-4587
Fax Number	:	786-231-5434

Provider Business Practice Location Address
First Line	:	925 W 41ST ST STE 300
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3339
Country	:	US
Telephone Number	:	954-993-4587
Fax Number	:	786-231-5434

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2013
Last Update Date	:	11/16/2021

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