| Bush Md Pc | |
|
3156 Willowcreek Rd Portage IN 46368-4424 | |
| (219) 762-4999 | |
| Not Available |
| Full Name | Bush Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 3156 Willowcreek Rd, Portage, Indiana |
| Authorized Official Name and Position | Lynn Mcdonald (CREDENTIALING) |
| Authorized Official Contact | 2197691670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bush Md Pc 55 E 86th Ave Merrillville IN 46410-6382 Ph: (219) 769-1670 | Bush Md Pc 3156 Willowcreek Rd Portage IN 46368-4424 Ph: (219) 762-4999 |
| NPI Number | 1851931299 |
|---|---|
| Provider Enumeration Date | 01/14/2020 |
| Last Update Date | 01/14/2020 |
| Medicare PECOS PAC ID | 4981030822 |
|---|---|
| Medicare Enrollment ID | O20200212001593 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851931299 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Shane D Bush |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316258874 PECOS PAC ID: 7810149234 Enrollment ID: I20130828000182 |
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