Provider Demographics
NPI:1346272960
Name:BUSTIN, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:BUSTIN
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 1:107 DIAGNOSTIC DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-6524
Mailing Address - Country:US
Mailing Address - Phone:502-875-9885
Mailing Address - Fax:502-875-9882
Practice Address - Street 1:107 DIAGNOSTIC DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6524
Practice Address - Country:US
Practice Address - Phone:502-875-9885
Practice Address - Fax:502-875-9882
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19944207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64199441Medicaid
KY000000645705OtherANTHEM
KYC68529Medicare UPIN
KY000000645705OtherANTHEM