MEDICARE: KATHERINE MICHELLE BUSSLEMAN

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	171000000X	Military Health Care Provider

General Provider Information

NPI Number	:	1366420234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MICHELLE BUSSLEMAN

Provider Business Mailing Address
First Line	:	10727 S PRESERVE WAY
Second Line	:	#103
City	:	MIRAMAR
State	:	FL
Zip	:	33025-6527
Country	:	US
Telephone Number	:	305-953-2266
Fax Number	:

Provider Business Practice Location Address
First Line	:	10727 S PRESERVE WAY
Second Line	:	#103
City	:	MIRAMAR
State	:	FL
Zip	:	33025-6527
Country	:	US
Telephone Number	:	305-953-2266
Fax Number	:

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

Provider Enumeration Date	:	01/02/2006
Last Update Date	:	07/21/2022

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