Basic Information
| Provider Information | |||||||||
| NPI: | 1023091501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUSCH | ||||||||
| FirstName: | CALVERT | ||||||||
| MiddleName: | RAYMOND | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1380 E STROOP RD | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454294926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372933486 | ||||||||
| FaxNumber: | 9372933605 | ||||||||
| Practice Location | |||||||||
| Address1: | 1380 E STROOP RD | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454294926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372933486 | ||||||||
| FaxNumber: | 9372933605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2005 | ||||||||
| LastUpdateDate: | 04/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35043378 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 000000039027 | 01 | OH | ANTHEM | OTHER | 2153717 | 01 | OH | AETNA | OTHER | 0398181 | 05 | OH | MEDICAID | 060053779 | 01 | OH | RR MEDICARE | OTHER | 2501766 | 01 | OH | UNITED HEALTHCARE | OTHER |