Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 4301061649 | MI |
Y | 207PE0004X | Emergency Medical Services | 4301061649 | MI |
NPI | 1053328971 |
---|---|
Provider Name | Colleen M Bush |
First Address | Chicago, IL 60689-5325 |
Second Address | Grand Rapids, MI 49503-2560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 27/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
930043714 | RAILROAD MEDICARE (01) | MI |
G14774 | (02) | MI |
P00446307 | RAILROAD MEDICARE (01) | MI |