Organization
LUIS E BUSTOS M.D.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS E BUSTOS M.D. (PRESIDENT)
(586) 558-5666
Entity
Organization
Contact information
Practice address
29135 RYAN RD, SUITE B, WARREN, MI 48092-4276
(586) 558-5666
(586) 558-9333
Mailing address
29135 RYAN RD, SUITE B, WARREN, MI 48092-4276
(586) 558-5666
(586) 558-9333
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
4301032972
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0205006091
BLUE CROSS BLUE SHIELD MI
MI
05
—
101390582
—
MI
Enumeration date
03/07/2008
Last updated
03/07/2008
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