Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 4301044005 | MI |
NPI | 1003990037 |
---|---|
Provider Name | Dr. Maynard Buszek |
First Address | Southfield, MI 48034-1018 |
Second Address | Southfield, MI 48034-1018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B46012 | (02) | MI |