Provider Demographics
NPI:1659366920
Name:BUDNIK, TIMOTHY R (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:BUDNIK
Suffix:
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 1:41 COMMERCE PARK DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8348
Mailing Address - Country:US
Mailing Address - Phone:614-797-3277
Mailing Address - Fax:614-794-9154
Practice Address - Street 1:41 COMMERCE PARK DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8348
Practice Address - Country:US
Practice Address - Phone:614-797-3277
Practice Address - Fax:614-794-9154
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006540B207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2177559Medicaid
H13582Medicare UPIN
BU4016801Medicare ID - Type Unspecified