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General NPI Number Information
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NPI Number | 1003098088
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Entity Type | Organization
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Legal Business Name | JANE E BISTLINE MD PA
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 2047 PALM BEACH LAKES BLVD SUITE 300
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-6500
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Country | US
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Telephone | 561-681-9808
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Fax | 561-681-9989
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Provider Business Mailing Address
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Address Line | 2047 PALM BEACH LAKES BLVD SUITE 300
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-6500
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Country | US
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Telephone | 561-681-9808
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Fax | 561-681-9989
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANE E BISTLINE
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Credential |
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Telephone | 561-681-9808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME64772
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License Number State | FL
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