Provider Demographics
NPI:1194210302
Name:BUSSARD, MICHAEL D (CERTIFIED ORTHOTIST)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:BUSSARD
Suffix:
Gender:M
Credentials:CERTIFIED ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202-2439
Mailing Address - Country:US
Mailing Address - Phone:412-327-5163
Mailing Address - Fax:
Practice Address - Street 1:3424 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15201-1323
Practice Address - Country:US
Practice Address - Phone:412-622-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOH0000059222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist