Provider Demographics
NPI:1295778157
Name:BUSCH, BENJAMIN A (DO)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:A
Last Name:BUSCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 W 63RD PL STE 201
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4034
Mailing Address - Country:US
Mailing Address - Phone:303-565-8483
Mailing Address - Fax:
Practice Address - Street 1:12001 W 63RD PL STE 201
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4034
Practice Address - Country:US
Practice Address - Phone:303-565-8483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49644204D00000X, 207RP1001X, 207SG0201X, 207K00000X, 207RC0000X, 207RE0101X, 207PS0010X, 202D00000X, 204C00000X, 208200000X, 2083T0002X, 2084P0301X, 2084S0010X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical Toxicology
No2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury Medicine
No2084S0010XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySports Medicine
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO021891OtherKAISER COMMERCIAL NUMBER
OH2606406Medicaid
CO53888031Medicaid
CO021891OtherKAISER COMMERCIAL NUMBER
OH4171301Medicare PIN
COCOAAA0168Medicare PIN