Healthcare Provider Details

I. General information

NPI: 1740210095
Provider Name (Legal Business Name): JACQUELINE MIODOWNIK-AISENBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8840 SW 40TH ST SUITE 100
MIAMI FL
33165-5482
US

IV. Provider business mailing address

8660 W FLAGLER ST SUITE 200
MIAMI FL
33144-2031
US

V. Phone/Fax

Practice location:
  • Phone: 305-227-3884
  • Fax: 305-554-4833
Mailing address:
  • Phone: 305-227-3884
  • Fax: 305-554-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberME89559
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: