Healthcare Provider Details

I. General information

NPI: 1356557631
Provider Name (Legal Business Name): TRI-COUNTY EMERGENCY PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W KING ST
OWOSSO MI
48867-2120
US

IV. Provider business mailing address

17717 MASONIC BLVD
FRASER MI
48026-3158
US

V. Phone/Fax

Practice location:
  • Phone: 517-487-5585
  • Fax: 517-487-1129
Mailing address:
  • Phone: 586-294-2700
  • Fax: 586-294-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH M BUSTAMANTE III
Title or Position: PRESIDENT
Credential: DO
Phone: 586-294-2700