Provider Demographics
NPI:1043568926
Name:LUEDERS, BRAD
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:LUEDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 WESSEX WAY
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-5662
Mailing Address - Country:US
Mailing Address - Phone:813-210-4128
Mailing Address - Fax:813-490-5459
Practice Address - Street 1:4823 WESSEX WAY
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5662
Practice Address - Country:US
Practice Address - Phone:813-210-4128
Practice Address - Fax:813-490-5459
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator