Provider Demographics
NPI:1841635620
Name:BUSHAN, SITA (MD)
Entity type:Individual
Prefix:
First Name:SITA
Middle Name:
Last Name:BUSHAN
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 1:7200 CAMBRIDGE STREET
Mailing Address - Street 2:BCM660
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-798-1963
Mailing Address - Fax:
Practice Address - Street 1:2525A HOLLY HALL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4124
Practice Address - Country:US
Practice Address - Phone:713-526-4243
Practice Address - Fax:713-440-1190
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC191483390200000X
TXR1506207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program