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 1:6161 N STATE HIGHWAY 161 STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2220
Mailing Address - Country:US
Mailing Address - Phone:972-258-7499
Mailing Address - Fax:972-870-7303
Practice Address - Street 1:6161 N STATE HIGHWAY 161 STE 200
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2220
Practice Address - Country:US
Practice Address - Phone:972-258-7499
Practice Address - Fax:972-870-7303
Is Sole Proprietor?:No
Enumeration Date:2013-12-22
Last Update Date:2024-10-02
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