Provider Demographics
NPI:1154347847
Name:WAIBEL, JILL S (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:WAIBEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7800 SW 87TH AVE
Mailing Address - Street 2:SUITE B200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-279-6060
Mailing Address - Fax:305-279-6548
Practice Address - Street 1:7800 SW 87TH AVE
Practice Address - Street 2:SUITE B200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-279-6060
Practice Address - Fax:305-279-6548
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35085133207N00000X
FLME99968207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000361974OtherANTHEM BLUE SHIELD
OHI26477Medicare UPIN