MEDICARE: LJB MD INC

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

General Provider Information

NPI Number	:	1811730674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LJB MD INC

Provider Business Mailing 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

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	:	OWNER
Name	:	LUCAS JEREMY BADER
Credential	:	MD
Telephone Number	:	786-539-2421

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	06/18/2024

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