Healthcare Provider Details

I. General information

NPI: 1811891963
Provider Name (Legal Business Name): MATTHEW BOJANOWSKI MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 SW 147TH CT
MIAMI FL
33194-2916
US

IV. Provider business mailing address

961 SW 147TH CT
MIAMI FL
33194-2916
US

V. Phone/Fax

Practice location:
  • Phone: 859-552-2249
  • Fax:
Mailing address:
  • Phone: 859-552-2249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MATTHEW TYLER BOJANOWSKI
Title or Position: OWNER
Credential: MD
Phone: 859-552-2249