MEDICARE: DR. ANIL KUMAR BADHWAR M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	C-8318	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992764260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANIL KUMAR BADHWAR M.D

Provider Business Mailing Address
First Line	:	11321 I-30 SUITE 308
Second Line	:	PETER THOMAS MEDICAL ARTS BUILDING
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-7067
Country	:	US
Telephone Number	:	501-455-7003
Fax Number	:	501-455-7047

Provider Business Practice Location Address
First Line	:	11321 INTERSTATE 30
Second Line	:	SUITE 308
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-7059
Country	:	US
Telephone Number	:	501-455-7003
Fax Number	:	501-455-7047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	01/25/2019

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