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General NPI Number Information
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NPI Number | 1124340435
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Entity Type | Organization
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Legal Business Name | BUSH FOOT & ANKLE LLC
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Dates
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Enumeration Date | 02/28/2010
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Last Update Date | 06/27/2010
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Provider Practice Location Address
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Address Line | 1640 SW 148TH TER
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-2355
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Country | US
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Telephone | 954-479-2260
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Fax | 954-241-1644
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Provider Business Mailing Address
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Address Line | 1640 SW 148TH TER
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-2355
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Country | US
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Telephone | 954-479-2260
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Fax | 954-241-1644
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Authorized Official
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Title or Position | OWNER
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Name | DR. NACERA BELKHEIR BUSH
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Credential | DPM
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Telephone | 954-479-2260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3373
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License Number State | FL
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