Provider Demographics
NPI:1467271171
Name:BUFORD, MICHELLE DEANN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DEANN
Last Name:BUFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 NW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-2821
Mailing Address - Country:US
Mailing Address - Phone:405-920-9478
Mailing Address - Fax:
Practice Address - Street 1:5350 S WESTERN AVE STE 102
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4509
Practice Address - Country:US
Practice Address - Phone:405-889-1562
Practice Address - Fax:877-632-2235
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator