Provider Demographics
NPI:1851391759
Name:BUSCEME, HEIDI W (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:W
Last Name:BUSCEME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1807 W SLAUGHTER LANE # 490
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6208
Practice Address - Country:US
Practice Address - Phone:512-282-8967
Practice Address - Fax:512-292-5135
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4826208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046614602Medicaid
TX046614603Medicaid
TX046614604Medicaid
AR137356001Medicaid
TX046614605Medicaid
TX046614601Medicaid
TX046614603Medicaid
TXTXB118673Medicare PIN
TX046614604Medicaid
TX046614601Medicaid
TXTXB118525Medicare PIN
TX046614602Medicaid