Healthcare Provider Details

I. General information

NPI: 1053656561
Provider Name (Legal Business Name): JEREMY SCOTT BLEICHER D.O., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 11/04/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 NE MIAMI GARDENS DR STE 155
NORTH MIAMI BEACH FL
33179-4747
US

IV. Provider business mailing address

1380 NE MIAMI GARDENS DR STE 155
NORTH MIAMI BEACH FL
33179-4747
US

V. Phone/Fax

Practice location:
  • Phone: 305-902-1663
  • Fax: 786-578-0232
Mailing address:
  • Phone: 305-431-2680
  • Fax: 786-578-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS12010
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberOS12010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: