Provider Demographics
NPI:1477699825
Name:BUDNICK, JOHN SR (DO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BUDNICK
Suffix:SR
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 1:5790 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-9440
Mailing Address - Country:US
Mailing Address - Phone:231-893-4200
Mailing Address - Fax:
Practice Address - Street 1:3625 CLYDE PARK AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49509-4103
Practice Address - Country:US
Practice Address - Phone:616-532-9299
Practice Address - Fax:616-831-9561
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006556207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine