Provider Demographics
NPI:1760458863
Name:BUSANICH, BRIAN MARTIN (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MARTIN
Last Name:BUSANICH
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1503 W NELSON ST
Mailing Address - Street 2:#3R
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3116
Mailing Address - Country:US
Mailing Address - Phone:773-220-0812
Mailing Address - Fax:708-222-5832
Practice Address - Street 1:1503 W NELSON ST
Practice Address - Street 2:#3R
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3116
Practice Address - Country:US
Practice Address - Phone:773-220-0812
Practice Address - Fax:708-222-5832
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer