Healthcare Provider Details

I. General information

NPI: 1629268842
Provider Name (Legal Business Name): JESSE O BASADRE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 SW 27TH AVE
MIAMI FL
33145
US

IV. Provider business mailing address

1699 SW 27TH AVE
MIAMI FL
33145-2074
US

V. Phone/Fax

Practice location:
  • Phone: 305-857-5025
  • Fax: 305-857-5024
Mailing address:
  • Phone: 305-857-5025
  • Fax: 305-857-5024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MILLIE APONTE
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-857-5025