Healthcare Provider Details

I. General information

NPI: 1649212952
Provider Name (Legal Business Name): BHEKUMUSA MSIBI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ASHLAND DR
MT PLEASANT MI
48858-1219
US

IV. Provider business mailing address

1970 ASHLAND DR
MT PLEASANT MI
48858-1219
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-1500
  • Fax: 989-772-9301
Mailing address:
  • Phone: 989-772-1500
  • Fax: 989-772-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101012162
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: