Healthcare Provider Details

I. General information

NPI: 1154305563
Provider Name (Legal Business Name): MICHAEL J BUECHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 COOLIDGE RD
EAST LANSING MI
48823-1378
US

IV. Provider business mailing address

1005 CHARLEVOIX DR STE 100
GRAND LEDGE MI
48837-8186
US

V. Phone/Fax

Practice location:
  • Phone: 517-337-1668
  • Fax: 517-337-1779
Mailing address:
  • Phone: 517-337-0316
  • Fax: 517-622-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301052697
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number4301052697
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: