Provider Demographics
NPI:1467532069
Name:BUDNICK, JULIUS JR (MD PC)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:
Last Name:BUDNICK
Suffix:JR
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 76510
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80970-6510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3010 N CIRCLE DR 200B
Practice Address - Street 2:
Practice Address - City:COLO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1174
Practice Address - Country:US
Practice Address - Phone:719-867-7373
Practice Address - Fax:719-867-7374
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01328848Medicaid
COC14841Medicare PIN
CO01328848Medicaid