MEDICARE: MARK A BUSTAMANTE 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
1	207R00000X	Internal Medicine Physician	4301054000	MI

General Provider Information

NPI Number	:	1871568402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A BUSTAMANTE MD

Provider Business Mailing Address
First Line	:	PO BOX 746723
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6723
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:	773-866-8014

Provider Business Practice Location Address
First Line	:	102 W PIERSON RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48505-3348
Country	:	US
Telephone Number	:	810-222-3033
Fax Number	:

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	01/31/2023

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Directions to “ MARK A BUSTAMANTE MD” Practice Location

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