MEDICARE: DR. MARIANO BUSSO M.D., P.A.

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	207NS0135X	Procedural Dermatology Physician	ME0065566	FL

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	:	1346229978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIANO BUSSO M.D., P.A.

Provider Business Mailing Address
First Line	:	3006 AVIATION AVE
Second Line	:	SUITE 2C
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-3863
Country	:	US
Telephone Number	:	305-857-0144
Fax Number	:

Provider Business Practice Location Address
First Line	:	3006 AVIATION AVE
Second Line	:	SUITE 2C
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-3863
Country	:	US
Telephone Number	:	305-857-0144
Fax Number	:

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	01/23/2013

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