Provider Demographics
NPI:1609166313
Name:BUDZIAKOWSKA, MAGDALENA
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:BUDZIAKOWSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 HOUMA BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2944
Mailing Address - Country:US
Mailing Address - Phone:504-889-5242
Mailing Address - Fax:504-780-9251
Practice Address - Street 1:4315 HOUMA BLVD STE 303
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2944
Practice Address - Country:US
Practice Address - Phone:504-889-5242
Practice Address - Fax:504-780-9251
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.207021207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06155824Medicaid
LA1609166313OtherINDIVIDUAL NPI
MS06155824Medicaid