Provider Demographics
NPI:1801895388
Name:BRODY, MARTIN (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:BRODY
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 1:1325 NE 171ST ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2732
Mailing Address - Country:US
Mailing Address - Phone:305-652-4976
Mailing Address - Fax:305-652-7646
Practice Address - Street 1:1325 NE 171ST ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2732
Practice Address - Country:US
Practice Address - Phone:305-652-4976
Practice Address - Fax:305-652-7646
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2016-03-09
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
FLME15707207Y00000X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053562100Medicaid
FLD65669Medicare UPIN
FL053562100Medicaid