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General NPI Number Information
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NPI Number | 1730580457
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Entity Type | Organization
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Legal Business Name | JOHN C OELTJEN, MD, LLC
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Dates
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Enumeration Date | 09/12/2014
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Last Update Date | 09/12/2014
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Provider Practice Location Address
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Address Line | 8740 SW 88TH ST SUITE 218
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City | MIAMI
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State | FL
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Zip | 33176-2212
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Country | US
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Telephone | 305-974-1627
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Fax | 305-596-6120
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Provider Business Mailing Address
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Address Line | PO BOX 565715
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City | MIAMI
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State | FL
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Zip | 33256-5715
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Country | US
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Telephone | 305-974-1627
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Fax | 305-596-6120
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN C OELTJEN
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Credential | MD, PHD
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Telephone | 305-974-1627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | ME96192
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License Number State | FL
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