Healthcare Provider Details

I. General information

NPI: 1023147733
Provider Name (Legal Business Name): MICHAEL L BUZZELL LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 AUBURN ST
PORTLAND ME
04103-2141
US

IV. Provider business mailing address

94 AUBURN ST
PORTLAND ME
04103-2141
US

V. Phone/Fax

Practice location:
  • Phone: 207-776-0182
  • Fax: 207-797-7029
Mailing address:
  • Phone: 207-776-0182
  • Fax: 207-797-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMT3310
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: