Healthcare Provider Details

I. General information

NPI: 1205287638
Provider Name (Legal Business Name): SUZETTE K MILLINGTON-BUFFONG D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W MAIN ST
TROY OH
45373-3384
US

IV. Provider business mailing address

600 W MAIN ST
TROY OH
45373-3384
US

V. Phone/Fax

Practice location:
  • Phone: 937-980-7400
  • Fax:
Mailing address:
  • Phone: 937-980-7400
  • Fax: 937-980-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number1859-321
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.014593
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: