Provider Demographics
NPI:1992764260
Name:BADHWAR, ANIL KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:ANIL
Middle Name:KUMAR
Last Name:BADHWAR
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Gender:M
Credentials:MD
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Mailing Address - Street 1:11321 I-30 SUITE 308
Mailing Address - Street 2:PETER THOMAS MEDICAL ARTS BUILDING
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-7067
Mailing Address - Country:US
Mailing Address - Phone:501-455-7003
Mailing Address - Fax:501-455-7047
Practice Address - Street 1:11321 INTERSTATE 30
Practice Address - Street 2:SUITE 308
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-7059
Practice Address - Country:US
Practice Address - Phone:501-455-7003
Practice Address - Fax:501-455-7047
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2019-01-25
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Provider Licenses
StateLicense IDTaxonomies
ARC-8318207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122041001Medicaid
AR137625002Medicaid
AR122041001Medicaid
AR137625002Medicaid