Healthcare Provider Details

I. General information

NPI: 1275220550
Provider Name (Legal Business Name): ASA GRAY-BUCHTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W UNIVERSITY DR
ROCHESTER MI
48307-1863
US

IV. Provider business mailing address

1101 W UNIVERSITY DR
ROCHESTER MI
48307-1863
US

V. Phone/Fax

Practice location:
  • Phone: 248-601-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351051622
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: