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General NPI Number Information
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NPI Number | 1811309867
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Entity Type | Organization
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Legal Business Name | ALLERGY AND ASTHMA SPECIALISTS OF SOUTH FLORIDA LLC
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 05/27/2014
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Provider Practice Location Address
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Address Line | 1447 MEDICAL PARK BLVD SUITE 406
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City | WELLINGTON
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State | FL
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Zip | 33414-3164
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Country | US
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Telephone | 561-795-2006
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Fax | 561-795-8598
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Provider Business Mailing Address
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Address Line | 1447 MEDICAL PARK BLVD SUITE 406
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City | WELLINGTON
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State | FL
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Zip | 33414-3164
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Country | US
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Telephone | 561-795-2006
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Fax | 561-795-8598
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DANIEL HEATH BRODTMAN
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Credential | D.O.
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Telephone | 561-795-2006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | OS8623
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License Number State | FL
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