Provider Demographics
NPI:1447355789
Name:BISTLINE, JANE (MD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:BISTLINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2047 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6500
Mailing Address - Country:US
Mailing Address - Phone:561-681-9808
Mailing Address - Fax:561-698-9499
Practice Address - Street 1:2047 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6500
Practice Address - Country:US
Practice Address - Phone:561-681-9808
Practice Address - Fax:561-698-9499
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME67442174400000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF71321Medicare UPIN