Provider Demographics
NPI:1922590801
Name:BUDISIDHARTA, HARRY (JD)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:
Last Name:BUDISIDHARTA
Suffix:
Gender:M
Credentials:JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 ALTON ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-1712
Mailing Address - Country:US
Mailing Address - Phone:303-923-6370
Mailing Address - Fax:303-923-2951
Practice Address - Street 1:1537 ALTON ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-1712
Practice Address - Country:US
Practice Address - Phone:303-923-6370
Practice Address - Fax:303-923-2951
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator