Basic Information
| Provider Information | |||||||||
| NPI: | 1073552253 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSHEY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 E CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043305717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076221959 | ||||||||
| FaxNumber: | 2076221959 | ||||||||
| Practice Location | |||||||||
| Address1: | 149 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049014974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078721270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 03/21/2011 | ||||||||
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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 | 207L00000X | 013151 | ME | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | C65782 | 01 | ME | HARVARD | OTHER | 4723322 | 01 | ME | CIGNA | OTHER | 1042109 | 01 | ME | AETNA | OTHER | 268420099 | 05 | ME | MEDICAID | 003615 | 01 | ME | ANTHEM | OTHER |