Healthcare Provider Details

I. General information

NPI: 1568517456
Provider Name (Legal Business Name): MADHU BUDHRAJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/31/2021
Certification Date: 07/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SAINT VINCENT CIR
LITTLE ROCK AR
72205-5423
US

IV. Provider business mailing address

2 SAINT VINCENT CIR
LITTLE ROCK AR
72205-5423
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-4677
  • Fax: 501-552-4555
Mailing address:
  • Phone: 501-552-4677
  • Fax: 501-552-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberR3862
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: