Provider Demographics
NPI:1972815272
Name:BUKAVYN, YURIY (MD)
Entity type:Individual
Prefix:DR
First Name:YURIY
Middle Name:
Last Name:BUKAVYN
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:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-333-6562
Mailing Address - Fax:517-333-6563
Practice Address - Street 1:2682 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5608
Practice Address - Country:US
Practice Address - Phone:517-333-6562
Practice Address - Fax:517-333-6563
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine