Provider Demographics
NPI:1720047954
Name:DEMAIO, JAMIE MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MICHELLE
Last Name:DEMAIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 LAKELAND HILLS BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3208
Mailing Address - Country:US
Mailing Address - Phone:863-688-5811
Mailing Address - Fax:863-688-5866
Practice Address - Street 1:1417 LAKELAND HILLS BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3208
Practice Address - Country:US
Practice Address - Phone:863-688-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10638208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR200090OtherMEDICARE Y MUCHO MAS
PR201780OtherUTI PREFERRED
PR060882OtherCRUZ AZUL
PR3110638OtherU.I.A.
PR6560029OtherHUMANA INSURANCE
PRPG 3787OtherPANAMERICAN LIFE INSURANC
PR012232OtherHUMANA HEALTH PLAN
PR2104OtherPREFERRED MEDICARE CHOICE
PR89997DEOtherTRIPLE S
PR89997DEOtherTRIPLE S
PR89997Medicare ID - Type UnspecifiedMEDICARE