Provider Demographics
NPI:1972703379
Name:BUSSE, RACHEL JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:JOY
Last Name:BUSSE
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2470 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2123
Practice Address - Country:US
Practice Address - Phone:502-454-9151
Practice Address - Fax:502-456-3988
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253553207Q00000X
KY43776207Q00000X
CODR45201207Q00000X
KYTP279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50029623OtherPASSPORT/PASSPORT ADV FPA
KY50029622OtherPASSPORT/PASSPORT ADV HFM
KY7100127380Medicaid
KY50029623OtherPASSPORT/PASSPORT ADV FPA
KY7100127380Medicaid