Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | KB050601 | MI |
N | 207RA0401X | Internist - Addiction Medicine | KB050601 | MI |
NPI | 1881638625 |
---|---|
Provider Name | Kastytis Leonas Buitkus |
First Address | West Bloomfield, MI 48322-2660 |
Second Address | Oak Park, MI 48237-2581 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 13/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A99275 | (02) | MI |