| Blandine B Bustamante, MD | |
|
2200 Randallia Dr, Ft Wayne, IN 46805-4638 | |
| (260) 424-2195 | |
| Not Available |
| Full Name | Blandine B Bustamante |
|---|---|
| Gender | Female |
| Speciality | Pathology - Anatomic Pathology & Clinical Pathology |
| Location | 2200 Randallia Dr, Ft Wayne, Indiana |
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093799546 | NPI | - | NPPES |
| 200002580 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207ZP0102X | Pathology - Anatomic Pathology & Clinical Pathology | 01042290A (Indiana) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Blandine B Bustamante, MD 2458 Lake Ave, Fort Wayne, IN 46805-5406 Ph: (260) 424-2195 | Blandine B Bustamante, MD 2200 Randallia Dr, Ft Wayne, IN 46805-4638 Ph: (260) 424-2195 |
Darryl Smith, Pathology Medicare: Not Enrolled in Medicare Practice Location: 2200 Randallia Dr, Ft Wayne, IN 46805 Phone: 800-899-5757 | |
Shuishih Sage Lee, Pathology Medicare: Not Enrolled in Medicare Practice Location: 2200 Randallia Dr, Ft Wayne, IN 46805 Phone: 800-899-5757 | |
Ralph Craig Mcbride, Pathology Medicare: Accepting Medicare Assignments Practice Location: 2200 Randallia Dr, Ft Wayne, IN 46805 Phone: 800-899-5757 | |
Xiaoying Wan, M.D. Pathology Medicare: Accepting Medicare Assignments Practice Location: 2200 Randallia Dr, Ft Wayne, IN 46805 Phone: 800-899-5757 |