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General NPI Number Information
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NPI Number | 1609141506
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Entity Type | Organization
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Legal Business Name | KASTYTIS BUITKUS MD PC
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Dates
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Enumeration Date | 03/12/2012
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Last Update Date | 03/24/2012
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Provider Practice Location Address
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Address Line | 1265 NORTH MILFORDN RD
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City | MILFORD
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State | MI
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Zip | 48381
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Country | US
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Telephone | 248-685-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 6593 MINNOW POND DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-2660
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Country | US
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Telephone | 248-926-4047
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KASTYTIS BUITKUS
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Credential | MD
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Telephone | 248-926-4047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | KB 050601
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License Number State | MI
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