Provider Demographics
NPI:1649826777
Name:BUSCH, TIMOTHY G
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:G
Last Name:BUSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 S DEER TRL
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-7833
Mailing Address - Country:US
Mailing Address - Phone:573-772-0949
Mailing Address - Fax:
Practice Address - Street 1:1195 S DEER TRL
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-7833
Practice Address - Country:US
Practice Address - Phone:573-772-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider