Provider Demographics
NPI:1932113123
Name:NITZBERG, BRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:NITZBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 203A
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4636
Mailing Address - Country:US
Mailing Address - Phone:954-755-1946
Mailing Address - Fax:954-755-7789
Practice Address - Street 1:5401 N UNIVERSITY DR
Practice Address - Street 2:SUITE 203A
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4636
Practice Address - Country:US
Practice Address - Phone:954-755-1946
Practice Address - Fax:954-755-7789
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 56491207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE13091Medicare UPIN
FL09532Medicare ID - Type Unspecified
FL09532CMedicare ID - Type Unspecified