Provider Demographics
NPI:1285922328
Name:CUDDEBACK, ARJUNA JAMES (DO)
Entity type:Individual
Prefix:
First Name:ARJUNA
Middle Name:JAMES
Last Name:CUDDEBACK
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 1:616 MEIJER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-8457
Mailing Address - Country:US
Mailing Address - Phone:517-543-7976
Mailing Address - Fax:
Practice Address - Street 1:616 MEIJER DR STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-8457
Practice Address - Country:US
Practice Address - Phone:517-543-7976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004984A207X00000X
MI5101027647207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201409810Medicaid