Individual
DR. CHARLES A BUSH-JOSEPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1611 W HARRISON ST STE 400, CHICAGO, IL 60612-4861
(877) 632-6637
(708) 409-5179
Mailing address
1611 W HARRISON ST STE 400, CHICAGO, IL 60612-4861
(877) 632-6637
(708) 409-5179
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
01079047A
IN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
036070386
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
207067
MEDICARE PTAN LOCALITY 16
IL
01
—
207073
MEDICARE PTAN LOCALITY 15
IL
01
—
4120999
AETNA
—
01
—
DA4902
RAILROAD MEDICARE PTAN
—
01
—
P00202615
RAILROAD MEDICARE
—
Enumeration date
01/10/2006
Last updated
09/18/2023
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