Healthcare Provider Details

I. General information

NPI: 1790170629
Provider Name (Legal Business Name): SCOTT BRIAN BUCHOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E BELTLINE AVE NE STE 100
GRAND RAPIDS MI
49506-1267
US

IV. Provider business mailing address

330 E BELTLINE AVE NE STE 100
GRAND RAPIDS MI
49506-1267
US

V. Phone/Fax

Practice location:
  • Phone: 616-752-6235
  • Fax: 616-752-6324
Mailing address:
  • Phone: 616-752-6235
  • Fax: 616-752-6324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301115803
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301115803
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: