Basic Information
| Provider Information | |||||||||
| NPI: | 1518279884 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BUI | ||||||||
| FirstName: | DUY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2823 GRAYSON ST | ||||||||
| Address2: | |||||||||
| City: | FERNDALE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482201067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055094466 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6071 W OUTER DR | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482352624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137455146 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2010 | ||||||||
| LastUpdateDate: | 07/02/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 4301096926 | MI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 4301096926 | 01 | MI | PHYSICIAN EDUCATIONAL LIMITED LICENSE | OTHER |