1245461292 NPI number — STEPHANIE T BUI D.O.

Table of content: STEPHANIE T BUI D.O. (NPI 1245461292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245461292 NPI number — STEPHANIE T BUI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUI
Provider First Name:
STEPHANIE
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245461292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
363 FREMONT ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49017-3389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-245-8350
Provider Business Mailing Address Fax Number:
269-245-8305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
363 FREMONT ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49017-3389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-245-8350
Provider Business Practice Location Address Fax Number:
269-245-8305
Provider Enumeration Date:
08/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  5101018212 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 5101018212 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5101018212 . This is a "EDUCATIONAL LIMITED LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com