Provider Demographics
NPI:1043553563
Name:MAIT, JARRED EVAN (MD)
Entity type:Individual
Prefix:DR
First Name:JARRED
Middle Name:EVAN
Last Name:MAIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:925 W 41ST ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3339
Mailing Address - Country:US
Mailing Address - Phone:954-993-4587
Mailing Address - Fax:786-231-5434
Practice Address - Street 1:925 W 41ST ST STE 300
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3339
Practice Address - Country:US
Practice Address - Phone:954-993-4587
Practice Address - Fax:786-231-5434
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME 124911208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program