Healthcare Provider Details

I. General information

NPI: 1922091248
Provider Name (Legal Business Name): JORGE C BUSSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9193 SUNSET DR SUITE 200
MIAMI FL
33173-3487
US

IV. Provider business mailing address

9193 SUNSET DR SUITE 200
MIAMI FL
33173-3487
US

V. Phone/Fax

Practice location:
  • Phone: 305-273-9377
  • Fax: 305-273-9388
Mailing address:
  • Phone: 305-273-9377
  • Fax: 305-273-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME0043751
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: