Healthcare Provider Details

I. General information

NPI: 1770842429
Provider Name (Legal Business Name): MICHELLE BUEHNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PINION DRIVE, 10TH MEDICAL GROUP
USAF ACADEMY CO
80840
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-5140
  • Fax:
Mailing address:
  • Phone: 970-624-2403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101255763
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101255763
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0062790
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: