Provider Demographics
NPI:1609941244
Name:BASADRE, JESSE ORLANDO (MD PA)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:ORLANDO
Last Name:BASADRE
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2074
Mailing Address - Country:US
Mailing Address - Phone:305-857-5025
Mailing Address - Fax:305-857-5024
Practice Address - Street 1:1699 SW 27 AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145
Practice Address - Country:US
Practice Address - Phone:305-857-5025
Practice Address - Fax:305-857-5024
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00604672086S0122X, 2086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
E96745Medicare UPIN
12804Medicare ID - Type Unspecified