MEDICARE: DR. LUCAS JEREMY BADER 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	207X00000X	Orthopaedic Surgery Physician	A112030	CA
2	207XX0801X	Orthopaedic Trauma Physician	ME95823	FL
3	207X00000X	Orthopaedic Surgery Physician	ME95823	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	OD888	OTHER	FL	MEDICARE HFMG
5	OD890	OTHER	FL	MEDICARE HFPSI

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518168806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCAS JEREMY BADER MD

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-434-1401
Fax Number	:

Provider Business Practice Location Address
First Line	:	12550 BISCAYNE BLVD STE 405
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2539
Country	:	US
Telephone Number	:	786-539-2421
Fax Number	:	786-619-3366

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	06/18/2024

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Directions to “ DR. LUCAS JEREMY BADER MD” Practice Location

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