Provider Demographics
NPI:1609281682
Name:BUSHEY, EMILY M (DO)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:BUSHEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:M
Other - Last Name:HAUGUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5693 YMCA PARK DR W
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-3280
Practice Address - Country:US
Practice Address - Phone:260-425-6500
Practice Address - Fax:260-425-6505
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11017736A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine