Provider Demographics
NPI:1710103882
Name:BUSKEY, ALLEN (DPM)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:BUSKEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29045 FALL RIVER DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5234
Mailing Address - Country:US
Mailing Address - Phone:440-667-1523
Mailing Address - Fax:
Practice Address - Street 1:29045 FALL RIVER DR
Practice Address - Street 2:#4
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5234
Practice Address - Country:US
Practice Address - Phone:440-667-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.001923213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0443943Medicaid
OHT 80495Medicare UPIN
OH0484471Medicare ID - Type Unspecified