Healthcare Provider Details

I. General information

NPI: 1881636140
Provider Name (Legal Business Name): KUMARASWAMY BUDUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S WELLS ST APT 2103
CHICAGO IL
60607-4631
US

IV. Provider business mailing address

701 S WELLS ST APT 2103
CHICAGO IL
60607-4631
US

V. Phone/Fax

Practice location:
  • Phone: 440-317-1106
  • Fax:
Mailing address:
  • Phone: 440-317-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number62481
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35083493
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: