Individual
KEVIN WAYNE BUSDIECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
2500 METRO HEALTH DRIVE, CLEVELAND, OH 44109
(216) 778-5790
Mailing address
2500 METRO HEALTH DRIVE, CLEVELAND, OH 44109
(216) 778-5790
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
67-000036
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000232158
UNISON
OH
01
—
000000515962
ANTHEM
OH
01
—
0583328
BCMH
OH
05
—
2739264
—
OH
01
—
414955
WELLCARE MEDICAID
OH
01
—
430037559
RAILROAD MEDICARE
OH
01
—
9724074
AETNA
OH
Enumeration date
07/31/2006
Last updated
09/21/2009
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