Basic Information
| Provider Information | |||||||||
| NPI: | 1114966025 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BUDENBENDER | ||||||||
| FirstName: | KURT | ||||||||
| MiddleName: | T. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 645 E MISSOURI AVE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850121351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022628900 | ||||||||
| FaxNumber: | 6022628890 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 N CENTRAL AVE | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850044527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027444760 | ||||||||
| FaxNumber: | 6027444799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 02/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 20A8275 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 4586 | AZ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | P00667818 | 01 | MEDICARE RAILROAD | OTHER | 00AX82750 | 05 | CA | MEDICAID | 020A82750 | 01 | CA | BLUE SHIELD OF CA | OTHER | 221591 | 05 | AZ | MEDICAID |