Individual
DR. SHANE DAVID BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3630 WILLOWCREEK RD, PORTAGE, IN 46368-5075
(219) 364-3700
Mailing address
3630 WILLOWCREEK RD, PORTAGE, IN 46368-5075
(219) 707-1185
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01071914A
IN
Other
Enumeration date
06/29/2010
Last updated
06/02/2015
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