Individual
DR. JEREMY C BUSHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 MONROE AVE NW, GRAND RAPIDS, MI 49503-1455
(616) 732-6200
Mailing address
2060 EAST PARIS SEAVE 100, GRAND RAPIDS, MI 49546-6113
(616) 464-4610
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301096488
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301096488
EDUCATIONAL LIMITED LICENSE
MI
Enumeration date
07/16/2010
Last updated
08/04/2015
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