Healthcare Provider Details

I. General information

NPI: 1417056466
Provider Name (Legal Business Name): MICHAEL LYNNE BUZA MSW LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 STEVENS ST
FLINT MI
48502-1620
US

IV. Provider business mailing address

5277 WORCHESTER
SWARTZ CREEK MI
48473-1159
US

V. Phone/Fax

Practice location:
  • Phone: 810-232-6081
  • Fax: 810-232-6510
Mailing address:
  • Phone: 810-444-8564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801020837
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: