Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 000839 | IA |
NPI | 1033441589 |
---|---|
Provider Name | Bradly W. Bussewitz |
First Address | Iowa City, IA 52245-9509 |
Second Address | Iowa City, IA 52245-9509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2010 |
Last Update Date | 15/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3050442 | (05) | OH |