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General NPI Number Information
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NPI Number | 1205910254
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE CONSULTANTS PC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 29255 NORTHWESTERN HWY
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1018
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Country | US
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Telephone | 248-368-0100
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Fax | 248-350-8919
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Provider Business Mailing Address
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Address Line | 29255 NORTHWESTERN HWY
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1018
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Country | US
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Telephone | 248-368-0100
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Fax | 248-350-8919
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Authorized Official
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Title or Position | OWNER / CEO
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Name | DR. MAYNARD BUSZEK
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Credential | M.D.
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Telephone | 248-368-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 4301044005
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License Number State | MI
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