MEDICARE: STEPHEN MICHAEL BUSH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	2000158294	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023002573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN MICHAEL BUSH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 405454
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-5454
Country	:	US
Telephone Number	:	573-888-0555
Fax Number	:	573-888-0556

Provider Business Practice Location Address
First Line	:	509 SOUTH BYP
Second Line	:
City	:	KENNETT
State	:	MO
Zip	:	63857-3248
Country	:	US
Telephone Number	:	573-888-0555
Fax Number	:	573-888-0556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/23/2014

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