Provider Demographics
NPI:1760129142
Name:BUSK, COREY (CAPRC-1)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:BUSK
Suffix:
Gender:M
Credentials:CAPRC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 N MERIDIAN ST STE 340
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2850
Mailing Address - Country:US
Mailing Address - Phone:317-291-1967
Mailing Address - Fax:317-342-2916
Practice Address - Street 1:13993 E CARTER RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IN
Practice Address - Zip Code:47424-6125
Practice Address - Country:US
Practice Address - Phone:317-291-1967
Practice Address - Fax:317-342-2916
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCAPRC1-5427175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist