1669483194 NPI number — DANIEL AVERY BUSCH MD

Table of content: DANIEL AVERY BUSCH MD (NPI 1669483194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669483194 NPI number — DANIEL AVERY BUSCH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSCH
Provider First Name:
DANIEL
Provider Middle Name:
AVERY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669483194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
737 N. MICHIGAN AVENUE
Provider Second Line Business Mailing Address:
SUITE 1200
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-373-7300
Provider Business Mailing Address Fax Number:
312-573-1249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
737 N. MICHIGAN AVENUE
Provider Second Line Business Practice Location Address:
SUITE 1200
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-373-7300
Provider Business Practice Location Address Fax Number:
312-573-1249
Provider Enumeration Date:
08/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  036 055821 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036055821 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01615704 . This is a "BCBS ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 26001124 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".