MEDICARE: TIMOTHY R BUDNIK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	34006540B	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659366920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY R BUDNIK DO

Provider Business Mailing Address
First Line	:	41 COMMERCE PARK DR
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-8348
Country	:	US
Telephone Number	:	614-797-3277
Fax Number	:	614-794-9154

Provider Business Practice Location Address
First Line	:	41 COMMERCE PARK DR
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-8348
Country	:	US
Telephone Number	:	614-797-3277
Fax Number	:	614-794-9154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

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