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NPI Code Detail

MEDICARE: DR. MATTHEW L. BUSAM MD

MEDICARE: DR. MATTHEW L. BUSAM MD
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
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician036115554IL
2207XX0005XSports Medicine (Orthopaedic Surgery) Physician35.089716OH

General Provider Information

NPI Number : 1568417343
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW L. BUSAM MD
Provider Business Mailing Address
First Line : 6045 BRIDGETOWN RD
Second Line : STE 4
City : CINCINNATI
State : OH
Zip : 45248-3049
Country : US
Telephone Number : 513-347-9999
Fax Number : 513-347-3999
Provider Business Practice Location Address
First Line : 6045 BRIDGETOWN RD
Second Line : STE 4
City : CINCINNATI
State : OH
Zip : 45248-3049
Country : US
Telephone Number : 513-347-9999
Fax Number : 513-347-3999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2006
Last Update Date : 12/14/2016

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