Provider Demographics
NPI:1982857363
Name:BUDNICK, ELIOT ANDREW (DO)
Entity Type:Individual
Prefix:
First Name:ELIOT
Middle Name:ANDREW
Last Name:BUDNICK
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 1:451 SW BETHANY DR
Mailing Address - Street 2:SUITE #102
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1964
Mailing Address - Country:US
Mailing Address - Phone:772-202-2734
Mailing Address - Fax:
Practice Address - Street 1:451 SW BETHANY DR
Practice Address - Street 2:SUITE #102
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1964
Practice Address - Country:US
Practice Address - Phone:772-202-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010159312085R0202X
FLOS 107882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002276500Medicaid
FL002276500Medicaid