Provider Demographics
NPI:1679603070
Name:ANDREW G. BUSTIN, M.D., PLLC
Entity Type:Organization
Organization Name:ANDREW G. BUSTIN, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-875-9885
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19944207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64199441Medicaid
KYC68529Medicare UPIN
KY7933Medicare ID - Type Unspecified