Provider Demographics
NPI:1669461687
Name:BRATT, IRVING M (MD)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:M
Last Name:BRATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL034937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065813800Medicaid
79560XMedicare ID - Type Unspecified
FL065813800Medicaid