Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | ME122147 | FL |
Y | 208800000X | Urologist | RB047140 | MI |
NPI | 1003829201 |
---|---|
Provider Name | Robert Anthony Badalament |
First Address | Kissimmee, FL 34741-5005 |
Second Address | Kissimmee, FL 34741-5005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3192988-10 | (05) | MI |
OF323590 | BLUE CROSS BLUE SHIELD (01) | MI |