Provider Demographics
NPI:1134925548
Name:BUSH, RONALD DARRELL II
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:DARRELL
Last Name:BUSH
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 SAINT AUBIN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-1406
Mailing Address - Country:US
Mailing Address - Phone:313-969-5199
Mailing Address - Fax:
Practice Address - Street 1:4121 SAINT AUBIN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-1406
Practice Address - Country:US
Practice Address - Phone:313-969-5199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator