Healthcare Provider Details

I. General information

NPI: 1205910254
Provider Name (Legal Business Name): PHYSICAL MEDICINE CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29255 NORTHWESTERN HWY
SOUTHFIELD MI
48034-1018
US

IV. Provider business mailing address

29255 NORTHWESTERN HWY
SOUTHFIELD MI
48034-1018
US

V. Phone/Fax

Practice location:
  • Phone: 248-368-0100
  • Fax: 248-350-8919
Mailing address:
  • Phone: 248-368-0100
  • Fax: 248-350-8919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number4301044005
License Number StateMI

VIII. Authorized Official

Name: DR. MAYNARD BUSZEK
Title or Position: OWNER / CEO
Credential: M.D.
Phone: 248-368-0100