Provider Demographics
NPI:1407060585
Name:BUSH, TAMIKA CHERRON (DO)
Entity Type:Individual
Prefix:DR
First Name:TAMIKA
Middle Name:CHERRON
Last Name:BUSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21175 TOMBALL PKWY STE 379
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1655
Mailing Address - Country:US
Mailing Address - Phone:432-701-0093
Mailing Address - Fax:
Practice Address - Street 1:21175 TOMBALL PKWY # 379
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1655
Practice Address - Country:US
Practice Address - Phone:833-497-9429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-08-04
Deactivation Date:2022-07-28
Deactivation Code:
Reactivation Date:2022-08-04
Provider Licenses
StateLicense IDTaxonomies
TXR0366207P00000X, 208000000X
NC2008-01094208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909986Medicaid
TX373523502Medicaid