Healthcare Provider Details

I. General information

NPI: 1730666348
Provider Name (Legal Business Name): BRODIE PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9685 W BROWARD BLVD
PLANTATION FL
33324-2321
US

IV. Provider business mailing address

9685 W BROWARD BLVD
PLANTATION FL
33324-2321
US

V. Phone/Fax

Practice location:
  • Phone: 954-452-4590
  • Fax:
Mailing address:
  • Phone: 954-452-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3998
License Number StateFL

VIII. Authorized Official

Name: JESSICA MICHELLE BRODIE
Title or Position: PODIATRIST
Credential: DPM
Phone: 954-452-4590