Provider Demographics
NPI:1013196781
Name:IRVING M BRATT MD PA
Entity Type:Organization
Organization Name:IRVING M BRATT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-565-9966
Mailing Address - Street 1:1555 E OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4424
Mailing Address - Country:US
Mailing Address - Phone:954-565-9966
Mailing Address - Fax:954-565-0535
Practice Address - Street 1:1555 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4424
Practice Address - Country:US
Practice Address - Phone:954-565-9966
Practice Address - Fax:954-565-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE12009Medicare UPIN
FLK4426Medicare PIN