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General NPI Number Information
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NPI Number | 1780076380
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Entity Type | Organization
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Legal Business Name | DIGESTIVE WELLNESS CLINIC, PLLC
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 02/20/2015
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Provider Practice Location Address
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Address Line | 11321 INTERSTATE 30 STE. 100
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City | LITTLE ROCK
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State | AR
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Zip | 72209-7040
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Country | US
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Telephone | 501-407-2036
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Fax | 501-407-2129
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Provider Business Mailing Address
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Address Line | 11321 INTERSTATE 30 STE. 100
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City | LITTLE ROCK
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State | AR
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Zip | 72209-7040
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Country | US
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Telephone | 501-407-2036
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MEENAKSHI BUDHRAJA
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Credential | M.D.
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Telephone | 501-407-2036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | AR
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