Provider Demographics
NPI:1740280759
Name:HABUDA, BRADLEY A (DPM)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:HABUDA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:A
Other - Last Name:HABUDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:16251 N CLEVELAND AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:N FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-2176
Mailing Address - Country:US
Mailing Address - Phone:239-656-6565
Mailing Address - Fax:239-656-3081
Practice Address - Street 1:16251 N CLEVELAND AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:N FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-2176
Practice Address - Country:US
Practice Address - Phone:239-656-6565
Practice Address - Fax:239-656-3081
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3188213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5913ZMedicare ID - Type Unspecified
FLV06648Medicare UPIN