Provider Demographics
NPI:1033441589
Name:BUSSEWITZ, BRADLY W (DPM)
Entity Type:Individual
Prefix:
First Name:BRADLY
Middle Name:W
Last Name:BUSSEWITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-9509
Mailing Address - Country:US
Mailing Address - Phone:319-338-3606
Mailing Address - Fax:319-338-0522
Practice Address - Street 1:2751 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9509
Practice Address - Country:US
Practice Address - Phone:319-338-3606
Practice Address - Fax:319-338-0522
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000839213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3050442Medicaid
OH4291341Medicare PIN
OH3050442Medicaid