Provider Demographics
NPI:1124340435
Name:BUSH FOOT & ANKLE LLC
Entity type:Organization
Organization Name:BUSH FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NACERA
Authorized Official - Middle Name:BELKHEIR
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-479-2260
Mailing Address - Street 1:1640 SW 148TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2355
Mailing Address - Country:US
Mailing Address - Phone:954-479-2260
Mailing Address - Fax:954-241-1644
Practice Address - Street 1:1640 SW 148TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-2355
Practice Address - Country:US
Practice Address - Phone:954-479-2260
Practice Address - Fax:954-241-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-28
Last Update Date:2010-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3373213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty