Provider Demographics
NPI:1679808638
Name:BUDDE, PRAVEEN (MD)
Entity type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:
Last Name:BUDDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 PECANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-6010
Mailing Address - Country:US
Mailing Address - Phone:313-461-1663
Mailing Address - Fax:
Practice Address - Street 1:99 PECANWOOD DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-6010
Practice Address - Country:US
Practice Address - Phone:313-461-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR51457174400000X
LAMD.207797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist