Provider Demographics
NPI:1881638625
Name:BUITKUS, KASTYTIS LEONAS (MD)
Entity type:Individual
Prefix:
First Name:KASTYTIS
Middle Name:LEONAS
Last Name:BUITKUS
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 1:6593 MINNOW POND DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2660
Mailing Address - Country:US
Mailing Address - Phone:248-926-4047
Mailing Address - Fax:248-926-4049
Practice Address - Street 1:21700 GREENFIELD RD
Practice Address - Street 2:SUITE 130
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2581
Practice Address - Country:US
Practice Address - Phone:248-967-4310
Practice Address - Fax:248-967-4301
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKB050601207KA0200X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA99275Medicare UPIN
MI0632529Medicare ID - Type Unspecified