Provider Demographics
NPI:1720051584
Name:BUSENLEHNER, AUDRA LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:LEIGH
Last Name:BUSENLEHNER
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 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:813-444-5838
Mailing Address - Fax:
Practice Address - Street 1:3515 WATERMELON RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5174
Practice Address - Country:US
Practice Address - Phone:205-737-9024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I087305Medicare UPIN
ALG83380Medicare UPIN
AL051501433Medicare ID - Type Unspecified
AL051501433OtherBLUE CROSS BLUE SHIELD