MEDICARE: MICHAEL G BUSTOS

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	171M00000X	Case Manager/Care Coordinator	36051	TX

General Provider Information

NPI Number	:	1184967879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL G BUSTOS

Provider Business Mailing Address
First Line	:	360 LARCHMONT DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-4273
Country	:	US
Telephone Number	:	210-452-7937
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 LARCHMONT DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-4273
Country	:	US
Telephone Number	:	210-452-7937
Fax Number	:

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

Provider Enumeration Date	:	04/01/2013
Last Update Date	:	04/01/2013

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