Provider Demographics
NPI:1518962448
Name:BUDENSIEK, RICHARD LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:BUDENSIEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5623 WEST 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2901
Mailing Address - Country:US
Mailing Address - Phone:970-353-9011
Mailing Address - Fax:970-353-9135
Practice Address - Street 1:5623 WEST 19TH STREET
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2901
Practice Address - Country:US
Practice Address - Phone:970-353-9011
Practice Address - Fax:970-353-9135
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01321504Medicaid
COA02521Medicare UPIN
CO303159Medicare PIN
CO01321504Medicaid
COCO303159Medicare PIN