Provider Demographics
NPI:1114966025
Name:BUDENBENDER, KURT T (DO)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:T
Last Name:BUDENBENDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 E MISSOURI AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1351
Mailing Address - Country:US
Mailing Address - Phone:602-262-8900
Mailing Address - Fax:602-262-8890
Practice Address - Street 1:1850 N CENTRAL AVE
Practice Address - Street 2:SUITE 1600
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4527
Practice Address - Country:US
Practice Address - Phone:602-744-4760
Practice Address - Fax:602-744-4799
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8275207L00000X
AZ4586207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00667818OtherMEDICARE RAILROAD
CA00AX82750Medicaid
CA020A82750OtherBLUE SHIELD OF CA
AZ221591Medicaid
AZ221591Medicaid
CA020A82750OtherBLUE SHIELD OF CA
CAW20A8275AMedicare ID - Type Unspecified