Provider Demographics
NPI:1114908498
Name:BUSS, ROBERT O (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:O
Last Name:BUSS
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 1:1525 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2231
Mailing Address - Country:US
Mailing Address - Phone:262-786-3727
Mailing Address - Fax:
Practice Address - Street 1:1525 HAMILTON DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2231
Practice Address - Country:US
Practice Address - Phone:262-786-3727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16005207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32600600Medicaid
WI32600600Medicaid