Provider Demographics
NPI:1083139919
Name:SOUTH BEACH ENDOCRINE WELLNESS LLC
Entity Type:Organization
Organization Name:SOUTH BEACH ENDOCRINE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BLEICHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-431-2680
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:305-901-6238
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:305-431-2680
Practice Address - Fax:305-901-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12010207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty