Provider Demographics
NPI:1790170629
Name:BUCHOWSKI, SCOTT BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BRIAN
Last Name:BUCHOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 E BELTLINE AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1267
Mailing Address - Country:US
Mailing Address - Phone:616-752-6235
Mailing Address - Fax:616-752-6324
Practice Address - Street 1:330 E BELTLINE AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1267
Practice Address - Country:US
Practice Address - Phone:616-752-6235
Practice Address - Fax:616-752-6324
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036144044207R00000X
MI4301115803207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine