Healthcare Provider Details

I. General information

NPI: 1902134166
Provider Name (Legal Business Name): MICHAEL J. BUSCEMI JR DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10968 SHELDON RD
TAMPA FL
33626-4701
US

IV. Provider business mailing address

PO BOX 271329
TAMPA FL
33688-1329
US

V. Phone/Fax

Practice location:
  • Phone: 813-926-4010
  • Fax: 813-926-5424
Mailing address:
  • Phone: 813-926-4010
  • Fax: 813-926-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberOS4785
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberOS4785
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberOS4785
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberOS4785
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberOS4785
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOS4785
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS4785
License Number StateFL

VIII. Authorized Official

Name: MICHAEL J. BUSCEMI JR.
Title or Position: OWNER
Credential: DO
Phone: 813-926-4010