Individual
DR. LUIS E. BUSTOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
208600000X
Surgery Physician
Primary
4301032972
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0500609
BLUE CROSS BLUE SHIELD
MI
05
—
1390582
—
MI
Enumeration date
08/09/2005
Last updated
12/15/2009
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