=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154305563
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL J BUECHE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2005
-----------------------------------------------------
Last Update Date | 09/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 COOLIDGE RD
-----------------------------------------------------
City | EAST LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48823-1378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-337-1668
-----------------------------------------------------
Fax | 517-337-1779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1005 CHARLEVOIX DR STE 100
-----------------------------------------------------
City | GRAND LEDGE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48837-8186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-337-0316
-----------------------------------------------------
Fax | 517-622-1205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 4301052697
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207WX0009X
-----------------------------------------------------
Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number | 4301052697
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------