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General NPI Number Information
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NPI Number | 1114211554
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Entity Type | Individual
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Provider Name | JAIME LYNN BOZENTKA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 3100 SW 62ND AVE
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City | MIAMI
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State | FL
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Zip | 33155-3009
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Country | US
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Telephone | 646-939-0592
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Fax |
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Provider Business Mailing Address
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Address Line | 225 N COLUMBUS DR APT 5213
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City | CHICAGO
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State | IL
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Zip | 60601-5209
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Country | US
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Telephone | 646-939-0592
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | 35.823511
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | 036153164
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | TP381
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | ME155333
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License Number State | FL
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