Provider Demographics
NPI:1780076380
Name:DIGESTIVE WELLNESS CLINIC, PLLC
Entity type:Organization
Organization Name:DIGESTIVE WELLNESS CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEENAKSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDHRAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-407-2036
Mailing Address - Street 1:11321 INTERSTATE 30
Mailing Address - Street 2:STE. 100
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-7040
Mailing Address - Country:US
Mailing Address - Phone:501-407-2036
Mailing Address - Fax:
Practice Address - Street 1:11321 INTERSTATE 30
Practice Address - Street 2:STE. 100
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-7040
Practice Address - Country:US
Practice Address - Phone:501-407-2036
Practice Address - Fax:501-407-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty