Provider Demographics
NPI:1215021936
Name:SUDHA G MADABHUSHI MD INC
Entity Type:Organization
Organization Name:SUDHA G MADABHUSHI MD INC
Other - Org Name:ACCLAIM MEDICAL CARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MADABHUSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-929-6260
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92546-0661
Mailing Address - Country:US
Mailing Address - Phone:951-925-7179
Mailing Address - Fax:951-765-2855
Practice Address - Street 1:304 W LATHAM AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4106
Practice Address - Country:US
Practice Address - Phone:951-925-7170
Practice Address - Fax:951-925-7027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0104430Medicaid
CAGR0104430Medicaid