Healthcare Provider Details

I. General information

NPI: 1548456668
Provider Name (Legal Business Name): MICHAEL J BUSUITO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 KIRTS BLVD STE 700
TROY MI
48084-4881
US

IV. Provider business mailing address

1080 KIRTS BLVD STE 700
TROY MI
48084-4881
US

V. Phone/Fax

Practice location:
  • Phone: 248-362-2300
  • Fax: 248-362-5272
Mailing address:
  • Phone: 248-362-2300
  • Fax: 248-362-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J BUSUITO
Title or Position: OWNER
Credential: MD
Phone: 248-362-2300