Provider Demographics
NPI:1013172873
Name:KARL S BROT MD PA
Entity Type:Organization
Organization Name:KARL S BROT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-565-3838
Mailing Address - Street 1:1749 NE 26TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1428
Mailing Address - Country:US
Mailing Address - Phone:954-565-3838
Mailing Address - Fax:954-565-3893
Practice Address - Street 1:1749 NE 26TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1428
Practice Address - Country:US
Practice Address - Phone:954-565-3838
Practice Address - Fax:954-565-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1033292941OtherINDIVIDUAL NPI
FLE15821Medicare UPIN
FL79561Medicare PIN