Individual
DR. KOMALA N BHUSHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
512 N LECANTO HWY # 491, LECANTO, FL 34461-8547
(352) 527-2244
Mailing address
556 W BRITAIN ST, HERNANDO, FL 34442-8200
(352) 527-2944
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME06580
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201205
AMERI GROUP
FL
01
—
21644
HEALTHEASE & HEALTHYKIDS
FL
05
—
270492700
—
FL
01
—
74732
BLUE SHIELD PROVIDER#
FL
Enumeration date
12/12/2006
Last updated
10/17/2018
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