Provider Demographics
NPI:1922050756
Name:BUSCH, MICHAEL F (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:BUSCH
Suffix:
Gender:M
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:P.O. BOX 7547
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-7547
Mailing Address - Country:US
Mailing Address - Phone:706-389-3075
Mailing Address - Fax:706-389-3076
Practice Address - Street 1:1199 PRINCE AVENUE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2797
Practice Address - Country:US
Practice Address - Phone:706-389-3075
Practice Address - Fax:706-389-3076
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063717A2085R0202X
IL36-1150232085R0202X
GA0802192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00414287OtherMEDICARE RR
IN000000526572OtherANTHEM
IN200882040Medicaid
K28193Medicare UPIN
IN248640ZMedicare PIN
I53101Medicare UPIN