Healthcare Provider Details

I. General information

NPI: 1881661486
Provider Name (Legal Business Name): WILLIAM W BUSSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 S HILL DR
MADISON WI
53705-4639
US

IV. Provider business mailing address

5510 S HILL DR
MADISON WI
53705-4639
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number16121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: