Individual
THOMAS DEVERNE BUSSINEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
615 N MICHIGAN ST 1ST FL HOSPITALIST STE, SOUTH BEND, IN 46601-1033
(574) 647-3050
(574) 647-1094
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-3725
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02008147A
IN
208M00000X
Hospitalist Physician
02008147A
IN
208M00000X
Hospitalist Physician
5101025254
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300100592
—
IN
Enumeration date
06/20/2016
Last updated
03/30/2026
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