Individual
MR. GERALD M BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
451 HEALTH PKWY, SUITE B, PAW PAW, MI 49079-8242
(269) 655-3065
(269) 655-0585
Mailing address
451 HEALTH PKWY, SUITE B, PAW PAW, MI 49079-8242
(269) 655-3065
(269) 655-0585
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002068
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235195298
—
MI
01
—
700H060020
BCBSM - BRONSON LAKEVIEW
MI
Enumeration date
04/26/2006
Last updated
10/31/2014
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