Provider Demographics
NPI:1821028838
Name:BUSSCHOTS, GINETTE VACHON (MD)
Entity Type:Individual
Prefix:
First Name:GINETTE
Middle Name:VACHON
Last Name:BUSSCHOTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GINETTE
Other - Middle Name:
Other - Last Name:VACHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN AROBR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 EAST MEDICAL CENTER DR
Practice Address - Street 2:B1 FLOOR UNIVERSITY HOSPITAL RECP EMERGENCY
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5301
Practice Address - Country:US
Practice Address - Phone:734-936-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073820207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI930124114OtherRR MEDICARE
MI104435516Medicaid
MI4811024Medicaid
H74050Medicare UPIN
MIH74050Medicare UPIN
MI104435516Medicaid
MI4811024Medicaid