MEDICARE: BRAD NITZBERG 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	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1649635335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAD NITZBERG MD

Provider Business Mailing Address
First Line	:	5401 N UNIVERSITY DR
Second Line	:	SUITE 203A
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4636
Country	:	US
Telephone Number	:	954-755-1946
Fax Number	:	954-755-7789

Provider Business Practice Location Address
First Line	:	5401 N UNIVERSITY DR
Second Line	:	SUITE 203A
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4636
Country	:	US
Telephone Number	:	954-755-1946
Fax Number	:	954-755-7789

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. BRAD NITZBERG
Credential	:	MD
Telephone Number	:	954-755-1946

Provider Enumeration Date	:	12/22/2015
Last Update Date	:	12/22/2015

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