Healthcare Provider Details

I. General information

NPI: 1073562492
Provider Name (Legal Business Name): MILLIN CHANDU BUDEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 GATEWAY DR
LADSON SC
29456-3552
US

IV. Provider business mailing address

137 GATEWAY DR
LADSON SC
29456-3552
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-3676
  • Fax: 843-797-3677
Mailing address:
  • Phone: 843-797-3676
  • Fax: 843-797-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number21896
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: