Provider Demographics
NPI:1376610444
Name:BRAVO, KAREN R (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:BRAVO
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 1:15500 SW 200TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-3000
Mailing Address - Country:US
Mailing Address - Phone:305-505-0455
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-505-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA091825002085R0202X
FLME807102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP01097933OtherRR MEDICARE
NJ0305651Medicaid
NJP01097970OtherRR MEDICARE
FL259354800Medicaid
NJP01097924OtherRR MEDICARE
NJ0305651Medicaid
NJ246980ZEKDMedicare PIN
NJP01097970OtherRR MEDICARE
F85767Medicare UPIN
NJP01097933OtherRR MEDICARE