Provider Demographics
NPI:1518168806
Name:BADER, LUCAS JEREMY (MD)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:JEREMY
Last Name:BADER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-1401
Mailing Address - Fax:
Practice Address - Street 1:12550 BISCAYNE BLVD STE 405
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2539
Practice Address - Country:US
Practice Address - Phone:786-539-2421
Practice Address - Fax:786-619-3366
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112030207X00000X
FLME95823207XX0801X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02005067Medicaid
LA2432206Medicaid
FLOD888OtherMEDICARE HFMG
FL112202500Medicaid
FLOD890OtherMEDICARE HFPSI