Healthcare Provider Details

I. General information

NPI: 1962740621
Provider Name (Legal Business Name): MARY D BUSH, MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W 86TH ST SUITE 202
INDIANAPOLIS IN
46260-1907
US

IV. Provider business mailing address

2160 W 86TH ST SUITE 202
INDIANAPOLIS IN
46260-1907
US

V. Phone/Fax

Practice location:
  • Phone: 317-704-1084
  • Fax: 317-704-1087
Mailing address:
  • Phone: 317-704-1084
  • Fax: 317-704-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY BUSH
Title or Position: PRESIDENT
Credential: MD
Phone: 317-704-1084