Provider Demographics
NPI:1477608701
Name:BUSSELBERG, LORIN F (MD)
Entity Type:Individual
Prefix:DR
First Name:LORIN
Middle Name:F
Last Name:BUSSELBERG
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 1:1442 KINGWOOD DR # 279
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3040
Mailing Address - Country:US
Mailing Address - Phone:713-589-4863
Mailing Address - Fax:713-589-2284
Practice Address - Street 1:18955 N MEMORIAL DR
Practice Address - Street 2:STE 490
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4271
Practice Address - Country:US
Practice Address - Phone:713-589-4863
Practice Address - Fax:713-589-2284
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7675174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613791Medicare PIN