Provider Demographics
NPI:1356377196
Name:BACIK, BRADLEY M (DO)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:M
Last Name:BACIK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:9501 ROOSEVELT BLVD STE 501
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1030
Mailing Address - Country:US
Mailing Address - Phone:215-796-1223
Mailing Address - Fax:215-878-1379
Practice Address - Street 1:3907 LANKENAU AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2808
Practice Address - Country:US
Practice Address - Phone:215-796-1223
Practice Address - Fax:215-878-1379
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-03-21
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB07578600207RC0000X
PAOS-012698207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease