Provider Demographics
NPI:1952329609
Name:BUDEV-BUDDHDEV, CHANDU (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDU
Middle Name:
Last Name:BUDEV-BUDDHDEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHANDU
Other - Middle Name:
Other - Last Name:BUDEV-BUDDHDEV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:36115 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1216
Mailing Address - Country:US
Mailing Address - Phone:734-464-0887
Mailing Address - Fax:734-402-0254
Practice Address - Street 1:4142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:734-464-0887
Practice Address - Fax:734-402-0524
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038994207R00000X
KY17701207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64863194Medicaid
OH0302603Medicaid
C01405Medicare UPIN
KY1896401Medicare PIN
OHBU0430383Medicare ID - Type Unspecified