Provider Demographics
NPI:1447435706
Name:DANA M BUSCH DO PLLC
Entity type:Organization
Organization Name:DANA M BUSCH DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-674-4110
Mailing Address - Street 1:5624 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1926
Mailing Address - Country:US
Mailing Address - Phone:248-674-4110
Mailing Address - Fax:248-674-5409
Practice Address - Street 1:5624 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1926
Practice Address - Country:US
Practice Address - Phone:248-674-4110
Practice Address - Fax:248-674-5409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI02563068000OtherBCBS OF MICHIGAN
MI0P24820Medicare PIN