Provider Demographics
NPI:1144208950
Name:BUSH, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
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 1:8920 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 635
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2010
Mailing Address - Country:US
Mailing Address - Phone:310-652-3870
Mailing Address - Fax:310-652-4317
Practice Address - Street 1:8920 WILSHIRE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2003
Practice Address - Country:US
Practice Address - Phone:310-652-3870
Practice Address - Fax:310-652-4317
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38124174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG38124OtherLICENSE
CAG38124OtherLICENSE
CAB56221Medicare UPIN