MEDICARE: LUKE BASDEO 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	207RN0300X	Nephrology Physician	ME127148	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427491729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE BASDEO MD

Provider Business Mailing Address
First Line	:	1728 DUNLAWTON AVE STE 4
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2923
Country	:	US
Telephone Number	:	386-304-8302
Fax Number	:	386-304-8204

Provider Business Practice Location Address
First Line	:	1728 DUNLAWTON AVE STE 4
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2923
Country	:	US
Telephone Number	:	386-304-8302
Fax Number	:	386-304-8204

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

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	03/31/2021

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