MEDICARE: DR. KURT N BAUSBACK 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	207RI0011X	Interventional Cardiology Physician	G57335	CA

General Provider Information

NPI Number	:	1649258005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KURT N BAUSBACK MD

Provider Business Mailing Address
First Line	:	2350 W. EL CAMINO REAL
Second Line	:	2ND FLOOR
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-6203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2581 SAMARITAN DR
Second Line	:	STE 202
City	:	SAN JOSE
State	:	CA
Zip	:	95124-4113
Country	:	US
Telephone Number	:	408-358-3939
Fax Number	:	408-358-3797

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	03/21/2016

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