MEDICARE: ASA GRAY-BUCHTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4351051622	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program		AZ

General Provider Information

NPI Number	:	1275220550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASA GRAY-BUCHTA

Provider Business Mailing Address
First Line	:	1101 W UNIVERSITY DR
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48307-1863
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 W THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-4409
Country	:	US
Telephone Number	:	602-406-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	05/15/2026

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Directions to “ ASA GRAY-BUCHTA ” Practice Location

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