Healthcare Provider Details

I. General information

NPI: 1447355789
Provider Name (Legal Business Name): JANE BISTLINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 PALM BEACH LAKES BLVD SUITE 300
WEST PALM BEACH FL
33409-6500
US

IV. Provider business mailing address

2047 PALM BEACH LAKES BLVD SUITE 300
WEST PALM BEACH FL
33409-6500
US

V. Phone/Fax

Practice location:
  • Phone: 561-681-9808
  • Fax: 561-698-9499
Mailing address:
  • Phone: 561-681-9808
  • Fax: 561-698-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME67442
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME67442
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: