Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101017185 | MI |
N | 207Q00000X | Family Doctor | 5101017185 | MI |
NPI | 1477752327 |
---|---|
Provider Name | Dr. Amelia Louise Bueche |
First Address | Traverse City, MI 49684-4729 |
Second Address | Traverse City, MI 49684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 22/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
N27530076 | MEDICARE PTAN (01) | MI |