Individual
LUKE BASDEO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1728 DUNLAWTON AVE STE 4, PORT ORANGE, FL 32127-2923
(386) 304-8302
(386) 304-8204
Mailing address
1728 DUNLAWTON AVE STE 4, PORT ORANGE, FL 32127-2923
(386) 304-8302
(386) 304-8204
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
ME127148
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017894400
—
FL
Enumeration date
04/17/2013
Last updated
03/31/2021
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