Healthcare Provider Details

I. General information

NPI: 1598405565
Provider Name (Legal Business Name): LUCAS CHARLES ZADAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 38TH AVE N
ST PETERSBURG FL
33710-1629
US

IV. Provider business mailing address

21298 OLEAN BLVD
PORT CHARLOTTE FL
33952-6705
US

V. Phone/Fax

Practice location:
  • Phone: 727-384-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME170520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: