Provider Demographics
NPI:1033444070
Name:BUSENKELL, GARY LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LOUIS
Last Name:BUSENKELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2088 E RANCH RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3517
Mailing Address - Country:US
Mailing Address - Phone:480-839-1662
Mailing Address - Fax:
Practice Address - Street 1:2088 E RANCH RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3517
Practice Address - Country:US
Practice Address - Phone:480-839-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8143207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC99222Medicare UPIN