Provider Demographics
NPI:1467653840
Name:DAVID D BUDAJ PC
Entity Type:Organization
Organization Name:DAVID D BUDAJ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DUSAN
Authorized Official - Last Name:BUDAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-626-0001
Mailing Address - Street 1:5793 WEST MAPLE RD
Mailing Address - Street 2:SUITE 147
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-626-0001
Mailing Address - Fax:248-626-0008
Practice Address - Street 1:5793 WEST MAPLE RD
Practice Address - Street 2:SUITE 147
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-626-0001
Practice Address - Fax:248-626-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007674111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION88160Medicare ID - Type Unspecified