Healthcare Provider Details

I. General information

NPI: 1285922328
Provider Name (Legal Business Name): ARJUNA JAMES CUDDEBACK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 MEIJER DR STE 101
CHARLOTTE MI
48813-8457
US

IV. Provider business mailing address

616 MEIJER DR STE 101
CHARLOTTE MI
48813-8457
US

V. Phone/Fax

Practice location:
  • Phone: 517-543-7976
  • Fax:
Mailing address:
  • Phone: 517-543-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25IB12865600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101027647
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number02004984A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: