Provider Demographics
NPI:1598703480
Name:BUDDIGA, PRAVEEN (MD)
Entity Type:Individual
Prefix:
First Name:PRAVEEN
Middle Name:
Last Name:BUDDIGA
Suffix:
Gender:M
Credentials:MD
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 26270
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-6270
Mailing Address - Country:US
Mailing Address - Phone:559-421-9009
Mailing Address - Fax:559-922-2422
Practice Address - Street 1:7105 N CHESTNUT AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0357
Practice Address - Country:US
Practice Address - Phone:559-421-9009
Practice Address - Fax:559-922-2422
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90273207KA0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA115990OtherMEDICARE PTAN
CA1598703480Medicaid
CA115989OtherMEDICARE PTAN
CAGR0043790Medicaid
CAGR0043790Medicaid