Provider Demographics
NPI:1073632733
Name:BUSHELMAN, SUSAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:BUSHELMAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7766 EWING BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-7538
Mailing Address - Country:US
Mailing Address - Phone:859-283-1033
Mailing Address - Fax:859-283-1066
Practice Address - Street 1:7766 EWING BLVD
Practice Address - Street 2:STE 100
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7538
Practice Address - Country:US
Practice Address - Phone:859-283-1033
Practice Address - Fax:859-283-1066
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY30551207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
03-0055OtherUNITED HEALTCARE ID
3230980OtherAETNA ID
000000291599OtherANTHEM ID
KY1182305Medicare ID - Type Unspecified
03-0055OtherUNITED HEALTCARE ID