Provider Demographics
NPI:1700142510
Name:BUSCH, MIRIAM ESTHER (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:ESTHER
Last Name:BUSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:ESTHER
Other - Last Name:DARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:929 GRAHAM DR STE B
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3338
Mailing Address - Country:US
Mailing Address - Phone:281-351-5548
Mailing Address - Fax:281-351-5020
Practice Address - Street 1:929 GRAHAM DR STE B
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3338
Practice Address - Country:US
Practice Address - Phone:281-351-5548
Practice Address - Fax:281-351-5020
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206411174400000X
TXR9192207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2300164Medicaid