Provider Demographics
NPI:1881636140
Name:BUDUR, KUMARASWAMY (MD)
Entity Type:Individual
Prefix:
First Name:KUMARASWAMY
Middle Name:
Last Name:BUDUR
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 1:701 S WELLS ST APT 2103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4631
Mailing Address - Country:US
Mailing Address - Phone:440-317-1106
Mailing Address - Fax:
Practice Address - Street 1:701 S WELLS ST APT 2103
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4631
Practice Address - Country:US
Practice Address - Phone:440-317-1106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA624812084S0012X
OH350834932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00256996OtherMEDICARE RAILROAD
OHI02350Medicare UPIN
OH2474728Medicaid
OHBU7345671Medicare PIN