Provider Demographics
NPI:1891988796
Name:CLAUDIA L. BUSIEK, M.D. INC
Entity Type:Organization
Organization Name:CLAUDIA L. BUSIEK, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUSIEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-830-4001
Mailing Address - Street 1:1150 GRAHAM RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8077
Mailing Address - Country:US
Mailing Address - Phone:314-830-4001
Mailing Address - Fax:314-830-4647
Practice Address - Street 1:1150 GRAHAM RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8077
Practice Address - Country:US
Practice Address - Phone:314-830-4001
Practice Address - Fax:314-830-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODG3002OtherRAILROAD MEDICARE
MODG3002OtherRAILROAD MEDICARE