Healthcare Provider Details

I. General information

NPI: 1487664595
Provider Name (Legal Business Name): THOMAS E BUEKERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47601 GRAND RIVER AVE
NOVI MI
48374-1233
US

IV. Provider business mailing address

47601 GRAND RIVER AVE
NOVI MI
48374-1233
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-8607
  • Fax: 248-849-8108
Mailing address:
  • Phone: 248-849-8607
  • Fax: 248-849-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number31409
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number4301059565
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: