Provider Demographics
NPI:1245461292
Name:BUI, STEPHANIE T (DO)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:T
Last Name:BUI
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Gender:F
Credentials:DO
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Mailing Address - Street 1:363 FREMONT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3389
Mailing Address - Country:US
Mailing Address - Phone:269-245-8350
Mailing Address - Fax:269-245-8305
Practice Address - Street 1:363 FREMONT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3389
Practice Address - Country:US
Practice Address - Phone:269-245-8350
Practice Address - Fax:269-245-8305
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2020-12-09
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Provider Licenses
StateLicense IDTaxonomies
MI5101018212208D00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101018212OtherEDUCATIONAL LIMITED LICENSE