Provider Demographics
NPI:1427080407
Name:BUSUITO, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BUSUITO
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 1:1080 KIRTS BLVD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4881
Mailing Address - Country:US
Mailing Address - Phone:248-362-2300
Mailing Address - Fax:248-362-5272
Practice Address - Street 1:1080 KIRTS BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4881
Practice Address - Country:US
Practice Address - Phone:248-362-2300
Practice Address - Fax:248-362-5272
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMB045001208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4367747OtherAETNA
MIP41079OtherBLUE CARE NETWORK
MI2406342301OtherBCBS
MI4367747OtherAETNA
MIP41079OtherBLUE CARE NETWORK