Individual
PAUL P BUSSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11133 DUNN ROAD, ST LOUIS, MO 63136
(314) 653-4300
(314) 821-2180
Mailing address
1715 DEER TRACKS TRAIL, STE 130, ST LOUIS, MO 63131
(314) 821-5600
(314) 821-2180
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
34803
MO
2085R0202X
Diagnostic Radiology Physician
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006021895
IL BLUE
—
01
—
0360497781
IL CAID
—
01
—
1082742
MC MCAID
—
01
—
1390
MO BLUE
—
01
—
148419
H LINK
—
01
—
1609024
PH PLAN
—
01
—
25495
BLUE CHOICE
—
01
—
2781
GHP
—
01
—
300378
HLT PART
—
01
—
5493
HCARE USA
—
01
—
A12073
GATE WAY
—
01
—
L40183
IL CARE
—
Enumeration date
07/31/2006
Last updated
07/08/2007
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