MEDICARE: DR. BRIAN EDWARD GROTTKAU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	76630	MA
2	207X00000X	Orthopaedic Surgery Physician	166008	FL

General Provider Information

NPI Number	:	1477543080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN EDWARD GROTTKAU MD

Provider Business Mailing Address
First Line	:	1120 NW 14TH ST STE 1263
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-2107
Country	:	US
Telephone Number	:	305-243-3208
Fax Number	:	305-243-0338

Provider Business Practice Location Address
First Line	:	1120 NW 14TH ST STE 1263
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-2107
Country	:	US
Telephone Number	:	305-243-3208
Fax Number	:	305-243-0338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	01/11/2024

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