Healthcare Provider Details

I. General information

NPI: 1215590781
Provider Name (Legal Business Name): PAUL ANDREW BUSH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E SHERMAN BLVD
MUSKEGON MI
49444-1849
US

IV. Provider business mailing address

1500 CONCORD TER
SUNRISE FL
33323-2815
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-2000
  • Fax:
Mailing address:
  • Phone: 800-243-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704292547
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: