Provider Demographics
NPI:1659316800
Name:BUSH, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:BUSH
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 1:34 MAPLE ST
Mailing Address - Street 2:NORWALK HOSPITAL, 5TH FLOOR LABORATORY
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3815
Mailing Address - Country:US
Mailing Address - Phone:203-852-2649
Mailing Address - Fax:203-899-1518
Practice Address - Street 1:34 MAPLE ST
Practice Address - Street 2:NORWALK HOSPITAL, 5TH FLOOR LABORATORY
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3815
Practice Address - Country:US
Practice Address - Phone:203-852-2649
Practice Address - Fax:203-899-1518
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025206207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001252063P1OtherBLUE CARE FAMILY PLAN#
CT713482OtherCONNECTICARE#
CT0004407771OtherAETNA#
CT061113482OtherUNITED HEALTHCARE#
CT001252063Medicaid
CT061113482OtherOXFORD#
CT022040OtherHEALTHNET#
CT500HBL073CT01OtherBCBS GROUP#
CT061113482OtherPHCS#
CT4607645OtherCIGNA#
CT061113482OtherUNITED HEALTHCARE#
CT220000080Medicare ID - Type UnspecifiedMEDICARE#