MEDICARE: JERRAH PICKLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Y00000X	Otolaryngology Physician	ME173436	FL

General Provider Information

NPI Number	:	1134756000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRAH PICKLE MD

Provider Business Mailing Address
First Line	:	15280 NW 79TH CT STE 200
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5873
Country	:	US
Telephone Number	:	305-558-3724
Fax Number	:

Provider Business Practice Location Address
First Line	:	18501 PINES BLVD STE 210
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-1420
Country	:	US
Telephone Number	:	954-237-2506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	08/13/2025

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Directions to “ JERRAH PICKLE MD” Practice Location

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