Provider Demographics
NPI:1881705390
Name:BRODTMAN, DANIEL HEATH (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HEATH
Last Name:BRODTMAN
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 1:1447 MEDICAL PARK BLVD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3164
Mailing Address - Country:US
Mailing Address - Phone:561-795-2006
Mailing Address - Fax:561-795-8598
Practice Address - Street 1:1447 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 406
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3164
Practice Address - Country:US
Practice Address - Phone:561-795-2006
Practice Address - Fax:561-795-8598
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8623207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009789500Medicaid
1412142001OtherCIGNA PROVIDER NUMBER
207962OtherHEALTH EASE PROVIDER NO.
2865377OtherAETNA HMO PROVIDER NUMBER
1046965OtherCAREPLUS HMO PROVIDER NO.
207962OtherWELLCARE PROVIDER NUMBER
293152OtherAVMED CHOICE PROVIDER NO.
405674OtherAMERIHEALTH PROVIDER NO.
9974OtherDIMENSION
41608OtherNEIGHBORHOOD HEALTH PROV.
7592247OtherAETNA PPO PROVIDER NUMBER
1999822OtherFIRST HEALTH PROVIDER NO.
71556OtherBLUE CROSS PROVIDER NO.
P2799312OtherOXFORD HEALTH PROVIDER NO
112567OtherAMERIGROUP PROVIDER NUMBE
207962OtherWELLCARE PROVIDER NUMBER
FLE7878ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER