Provider Demographics
NPI:1942420641
Name:MICHAEL BUSH MD PLLC
Entity Type:Organization
Organization Name:MICHAEL BUSH MD PLLC
Other - Org Name:ADVANCED HEMORRHOID CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-795-6900
Mailing Address - Street 1:4323 E 5TH ST
Mailing Address - Street 2:#C
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2088
Mailing Address - Country:US
Mailing Address - Phone:520-795-6900
Mailing Address - Fax:520-795-2951
Practice Address - Street 1:4323 E 5TH ST
Practice Address - Street 2:#C
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2088
Practice Address - Country:US
Practice Address - Phone:520-795-6900
Practice Address - Fax:520-795-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14105174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0079201OtherBLUE CROSS BLUE SHIELD
AZ253526Medicaid
D36626Medicare UPIN