Healthcare Provider Details

I. General information

NPI: 1598703480
Provider Name (Legal Business Name): PRAVEEN BUDDIGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 N CHESTNUT AVE STE 103
FRESNO CA
93720-0357
US

IV. Provider business mailing address

PO BOX 26270
FRESNO CA
93729-6270
US

V. Phone/Fax

Practice location:
  • Phone: 559-421-9009
  • Fax: 559-922-2422
Mailing address:
  • Phone: 559-421-9009
  • Fax: 559-922-2422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberA90273
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA90273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: