MEDICARE: DR. JONAH DAVID BARDOS M.D.

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	207VE0102X	Reproductive Endocrinology Physician	ME131429	FL
2	207V00000X	Obstetrics & Gynecology Physician	ME131429	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME131429	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1164765012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONAH DAVID BARDOS M.D.

Provider Business Mailing Address
First Line	:	1140 KANE CONCOURSE FL 5
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2045
Country	:	US
Telephone Number	:	305-735-8000
Fax Number	:	904-344-5173

Provider Business Practice Location Address
First Line	:	2801 NW 79TH AVE STE 2000
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33122-1174
Country	:	US
Telephone Number	:	305-482-3813
Fax Number	:

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

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	10/06/2025

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