MEDICARE: DR. BRADLEY M BACIK D.O.

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	207RC0000X	Cardiovascular Disease Physician	25MB07578600	NJ
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	OS-012698	PA

General Provider Information

NPI Number	:	1356377196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY M BACIK D.O.

Provider Business Mailing Address
First Line	:	9501 ROOSEVELT BLVD STE 501
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1030
Country	:	US
Telephone Number	:	215-796-1223
Fax Number	:	215-878-1379

Provider Business Practice Location Address
First Line	:	3907 LANKENAU AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2808
Country	:	US
Telephone Number	:	215-796-1223
Fax Number	:	215-878-1379

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	03/21/2013

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