Individual
DR. EDWARD DANIEL NUSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
403 E MADISON ST, SOUTH BEND, IN 46617-2322
(574) 283-1234
Mailing address
PO BOX 809, GOSHEN, IN 46527-0809
(574) 533-1234
(574) 537-2652
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01063675A
IN
2084P0800X
Psychiatry Physician
01063675A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01063675A
INDIANA PHYSICIAN LICENSE
IN
Enumeration date
05/16/2007
Last updated
03/07/2023
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