Provider Demographics
NPI:1245237577
Name:BUSCHEMEYER, WILLIAM COOPER JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:COOPER
Last Name:BUSCHEMEYER
Suffix:JR
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 1:101 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3769
Mailing Address - Country:US
Mailing Address - Phone:812-282-3899
Mailing Address - Fax:812-282-4172
Practice Address - Street 1:101 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3769
Practice Address - Country:US
Practice Address - Phone:812-282-3899
Practice Address - Fax:812-282-4172
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16210208800000X
IN01025808A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64162100Medicaid
KYP00895271OtherRAILROAD MEDICARE
KYP00314085OtherRAILROAD MEDICARE
IN201028540Medicaid
11622462OtherCAQH PROVIDER ID
INM400040540Medicare PIN
KYP400034529Medicare PIN
D08089Medicare UPIN
IN201028540Medicaid