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NPI Code Detail

MEDICARE: RICHARD BUSH DO

MEDICARE: RICHARD BUSH DO
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
1174400000XSpecialist16612WV

General Provider Information

NPI Number : 1417972803
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD BUSH DO
Provider Business Mailing Address
First Line : 500 W BROWN DEER RD
Second Line : SUITE 202
City : BAYSIDE
State : WI
Zip : 53217-1618
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 500 W BROWN DEER RD
Second Line : SUITE 202
City : BAYSIDE
State : WI
Zip : 53217-1618
Country : US
Telephone Number : 414-434-0461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 07/08/2007

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