Provider Demographics
NPI:1336560101
Name:BUDHANI, ATIQ (DO)
Entity Type:Individual
Prefix:
First Name:ATIQ
Middle Name:
Last Name:BUDHANI
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 1:811 W INTERSTATE 20 STE 224
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5873
Mailing Address - Country:US
Mailing Address - Phone:817-807-9060
Mailing Address - Fax:
Practice Address - Street 1:811 W INTERSTATE 20 STE 224
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017
Practice Address - Country:US
Practice Address - Phone:817-807-9060
Practice Address - Fax:817-419-4505
Is Sole Proprietor?:No
Enumeration Date:2013-12-22
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350678401Medicaid
TX440503YNGSMedicare PIN