Provider Demographics
NPI:1073516829
Name:BUSH, EVERETT M (MD)
Entity Type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:M
Last Name:BUSH
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 1:2940 N MCCORD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1753
Mailing Address - Country:US
Mailing Address - Phone:419-842-3094
Mailing Address - Fax:419-842-3048
Practice Address - Street 1:2940 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1753
Practice Address - Country:US
Practice Address - Phone:419-842-3094
Practice Address - Fax:419-842-3048
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35034799B207RC0000X
MI4301050060207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0256735Medicaid
00454OtherPARAMOUNT
4215426OtherAETNA
000000603770OtherANTHEM
OH4010734Medicare PIN
OH4103924Medicare PIN
OHBU4103927Medicare PIN
OH4010733Medicare PIN
OH4010736Medicare PIN
OH060010775Medicare PIN
000000603770OtherANTHEM
OH0436159Medicare PIN
OH4010731Medicare PIN
OH4103922Medicare PIN
OH4103925Medicare PIN
OH4103926Medicare PIN
MI23450005Medicare PIN
4215426OtherAETNA
OH0436155Medicare PIN
OH0256735Medicaid
OH0436157Medicare PIN
OH4103923Medicare PIN