Healthcare Provider Details

I. General information

NPI: 1235680331
Provider Name (Legal Business Name): MICHAEL BUSCH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 GALLAGHER ST
SAGINAW MI
48601-3252
US

IV. Provider business mailing address

501 LAPEER AVE
SAGINAW MI
48607-1203
US

V. Phone/Fax

Practice location:
  • Phone: 989-755-3619
  • Fax: 989-755-3624
Mailing address:
  • Phone: 989-759-6464
  • Fax: 989-399-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704287965
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: