MEDICARE: JULIE E BUSCH MD

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	207Q00000X	Family Medicine Physician	2004012259	MO

General Provider Information

NPI Number	:	1568402501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE E BUSCH MD

Provider Business Mailing Address
First Line	:	1001 S KIRKWOOD RD
Second Line	:	STE 300
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-7254
Country	:	US
Telephone Number	:	314-543-5943
Fax Number	:	314-543-5953

Provider Business Practice Location Address
First Line	:	1001 S KIRKWOOD RD
Second Line	:	STE 300
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-7254
Country	:	US
Telephone Number	:	314-543-5943
Fax Number	:	314-543-5953

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	03/14/2017

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