Provider Demographics
NPI:1407413636
Name:BRZOBOHATY, MIROSLAV RAFAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MIROSLAV
Middle Name:RAFAEL
Last Name:BRZOBOHATY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7031 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4701
Mailing Address - Country:US
Mailing Address - Phone:305-284-7761
Mailing Address - Fax:
Practice Address - Street 1:9371 CYPRESS LAKE DR STE 12
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4995
Practice Address - Country:US
Practice Address - Phone:239-440-6456
Practice Address - Fax:239-236-0337
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine