Provider Demographics
NPI:1700857430
Name:BUSZ, SANDRA C (APRN C)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:C
Last Name:BUSZ
Suffix:
Gender:F
Credentials:APRN C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 S ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1752
Mailing Address - Country:US
Mailing Address - Phone:989-731-0658
Mailing Address - Fax:989-731-0681
Practice Address - Street 1:536 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1752
Practice Address - Country:US
Practice Address - Phone:989-731-0658
Practice Address - Fax:989-731-0681
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704158582207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4688270 10Medicaid
5008765110OtherBC BC
F88857Medicare UPIN
MI4688270 10Medicaid