Healthcare Provider Details

I. General information

NPI: 1063430734
Provider Name (Legal Business Name): RAYMOND H BUZENSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15500 19 MILE RD SUITE 300
CLINTON TWP MI
48038-6330
US

IV. Provider business mailing address

15500 19 MILE RD SUITE 300
CLINTON TWP MI
48038-6330
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-6464
  • Fax: 586-263-8491
Mailing address:
  • Phone: 586-263-6464
  • Fax: 586-263-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301058046
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: