Provider Demographics
NPI:1053656561
Name:BLEICHER, JEREMY SCOTT (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SCOTT
Last Name:BLEICHER
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1380 NE MIAMI GARDENS DR STE 155
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4747
Mailing Address - Country:US
Mailing Address - Phone:305-431-2680
Mailing Address - Fax:786-578-0232
Practice Address - Street 1:1380 NE MIAMI GARDENS DR STE 155
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4747
Practice Address - Country:US
Practice Address - Phone:305-902-1663
Practice Address - Fax:786-578-0232
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12010207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015255800Medicaid