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NPI Code Detail

MEDICARE: KEVIN MATTHEW BUCCI B.A.

MEDICARE: KEVIN MATTHEW BUCCI B.A.
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1295032738
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN MATTHEW BUCCI B.A.
Provider Business Mailing Address
First Line : 4902 S CEDAR ST
Second Line :
City : LANSING
State : MI
Zip : 48910-5474
Country : US
Telephone Number : 517-394-7867
Fax Number :
Provider Business Practice Location Address
First Line : 4902 S CEDAR ST
Second Line :
City : LANSING
State : MI
Zip : 48910-5474
Country : US
Telephone Number : 517-394-7867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2011
Last Update Date : 02/18/2011

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