Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 30020474 | OH |
Y | 213EG0000X | General Practice | 30020474 | OH |
NPI | 1003896473 |
---|---|
Provider Name | Dr. Todd Scott Busdiecker |
First Address | West Chester, OH 45069-4863 |
Second Address | West Chester, OH 45069-4863 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 08/07/2007 |