Provider Demographics
NPI:1215228572
Name:LIBES-BANDER, JAIME MICHELLE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:MICHELLE
Last Name:LIBES-BANDER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:92 W MILLER ST # MP318
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2032
Mailing Address - Country:US
Mailing Address - Phone:321-841-8588
Mailing Address - Fax:321-841-8560
Practice Address - Street 1:92 W MILLER ST # MP318
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2032
Practice Address - Country:US
Practice Address - Phone:321-841-8588
Practice Address - Fax:321-841-8560
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD49195208000000X
VA0101248768208000000X
IL036-1368202080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116515900Medicaid