MEDICARE: BRENDA S BUIS D.O.

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	207Q00000X	Family Medicine Physician	35-003584	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	9338635	OTHER	OH	PARTNERS PHYSICIAN GROUP MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1083864144	OTHER	OH	PORTAGE HILLS TYPE 2 NPI #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1841239274	OTHER	OH	PARTNERS PHYSICIAN GROUP TYPE 2 NPI #

General Provider Information

NPI Number	:	1881698413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA S BUIS D.O.

Provider Business Mailing Address
First Line	:	754 S CLEVELAND AVE
Second Line	:
City	:	MOGADORE
State	:	OH
Zip	:	44260-2205
Country	:	US
Telephone Number	:	330-628-2686
Fax Number	:	330-628-0828

Provider Business Practice Location Address
First Line	:	754 S CLEVELAND AVE
Second Line	:
City	:	MOGADORE
State	:	OH
Zip	:	44260-2205
Country	:	US
Telephone Number	:	330-628-2686
Fax Number	:	330-628-0828

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	03/29/2013

Similar Medicare Providers

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Practice Location Address:

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1548600463 — DR. ROBERT LOUIS DENNIS D.D.S.
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1104788611 — DESIREE CHAMBERS
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1417951039 — BRIAN R CAIN M.D.
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1184605289 — SCOTT R PHELPS OT
Practice Location Address:

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1700866449 — JOSEPH P BURICK DO
Practice Location Address:

754 S CLEVELAND AVE , SUITE 300
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Directions to “ BRENDA S BUIS D.O.” Practice Location

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