Provider Demographics
NPI: | 1760671390 |
---|---|
Name: | M.V. BUZZARD, M.D., P.C. |
Entity Type: | Organization |
Organization Name: | M.V. BUZZARD, M.D., P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MARK |
Authorized Official - Middle Name: | V |
Authorized Official - Last Name: | BUZZARD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 248-626-4600 |
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 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-10-19 |
Last Update Date: | 2007-10-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Single Specialty |