Basic Information
| Provider Information | |||||||||
| NPI: | 1659319820 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUDLER | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3806 NORMAL BLVD | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685065240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024899400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 S 48TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685061227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024890200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 21782 | NE | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 7714520 | 05 | SD | MEDICAID | 0550418 | 05 | IA | MEDICAID | 2087901701 | 05 | KS | MEDICAID |