Provider Demographics
NPI:1003920760
Name:BUXBAUM, MICHAEL E (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:BUXBAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 873
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0873
Mailing Address - Country:US
Mailing Address - Phone:713-533-1700
Mailing Address - Fax:713-533-1708
Practice Address - Street 1:3100 WESLAYAN ST STE 350
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5733
Practice Address - Country:US
Practice Address - Phone:713-533-1700
Practice Address - Fax:713-533-1708
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7677207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043941604Medicaid
TX8BG950OtherBCBS TX
TX611198Medicare ID - Type Unspecified
TX8B1975Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
TX108343OtherAMERIGROUP