MEDICARE: DR. CARL E. BUSSMANN M,D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	R7913	MO
2	2086S0127X	Trauma Surgery Physician	R7913	MO
3	2086S0129X	Vascular Surgery Physician	R7913	MO
4	207P00000X	Emergency Medicine Physician	R7913	MO
5	207P00000X	Emergency Medicine Physician	036117250	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053303636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL E. BUSSMANN M,D.

Provider Business Mailing Address
First Line	:	409 CONWAY VILLAGE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-5803
Country	:	US
Telephone Number	:	314-878-3571
Fax Number	:	314-439-9593

Provider Business Practice Location Address
First Line	:	11133 DUNN RD
Second Line	:	DEPARTMENT OF EMS
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6119
Country	:	US
Telephone Number	:	314-653-5663
Fax Number	:	314-653-4164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	06/26/2008

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Directions to “ DR. CARL E. BUSSMANN M,D.” Practice Location

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