Provider Demographics
NPI:1881698413
Name:BUIS, BRENDA S (DO)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:BUIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:S
Other - Last Name:HENSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:754 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-2205
Mailing Address - Country:US
Mailing Address - Phone:330-628-2686
Mailing Address - Fax:330-628-0828
Practice Address - Street 1:754 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-2205
Practice Address - Country:US
Practice Address - Phone:330-628-2686
Practice Address - Fax:330-628-0828
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-003584207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1083864144OtherPORTAGE HILLS TYPE 2 NPI #
OH0532034Medicaid
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH0532034Medicaid
OH4254121Medicare PIN