Healthcare Provider Details

I. General information

NPI: 1255312435
Provider Name (Legal Business Name): MICHAEL J BUSCEMI JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10968 SHELDON RD
TAMPA FL
33626-4701
US

IV. Provider business mailing address

10968 SHELDON RD
TAMPA FL
33626-4701
US

V. Phone/Fax

Practice location:
  • Phone: 813-926-4010
  • Fax:
Mailing address:
  • Phone: 813-926-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS0004785
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberOS4785
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberOS4785
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberOS4785
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: