Individual
MICHAEL M. BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601005629
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5390078
BCBS
MI
01
—
5601005629
PHYSICIAN ASSISTANT LICENSE
MI
Enumeration date
09/11/2009
Last updated
10/31/2014
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