Provider Demographics
NPI:1508954173
Name:BUZZARD, MARK V (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:V
Last Name:BUZZARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7001 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 424
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3604
Mailing Address - Country:US
Mailing Address - Phone:248-626-4600
Mailing Address - Fax:248-626-3988
Practice Address - Street 1:7001 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 424
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3604
Practice Address - Country:US
Practice Address - Phone:248-626-4600
Practice Address - Fax:248-626-3988
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010593982084F0202X, 2084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N58740Medicare ID - Type Unspecified
G31558Medicare UPIN