Provider Demographics
NPI:1346572138
Name:JUAN R. BOLET, M.D.P.A
Entity Type:Organization
Organization Name:JUAN R. BOLET, M.D.P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOLET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-856-4153
Mailing Address - Street 1:1800 PURDY AVE
Mailing Address - Street 2:APT. 1408
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1465
Mailing Address - Country:US
Mailing Address - Phone:305-856-4153
Mailing Address - Fax:786-275-6990
Practice Address - Street 1:1800 PURDY AVE
Practice Address - Street 2:APT. 1408
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-1465
Practice Address - Country:US
Practice Address - Phone:305-856-4153
Practice Address - Fax:786-275-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13524208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047013900Medicaid
FL90073Medicare PIN
FLD59037Medicare UPIN