Provider Demographics
NPI:1346228657
Name:BUSSE, KIRSTEN (MD)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:BUSSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912882
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-2882
Mailing Address - Country:US
Mailing Address - Phone:866-765-0909
Mailing Address - Fax:855-856-8520
Practice Address - Street 1:353 FAIRMONT BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-755-8222
Practice Address - Fax:605-719-4203
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1346228657Medicaid
NM10019722OtherLOVELACE HEALTH/SALUD
NM202000054OtherPRESBYTERIAN HEALTH/SALUD
AZ953697OtherAHCCCS
NMQMYPR0068290OtherMOLINA
NMNM007580OtherBC/BS
SD1346228657Medicaid
NM65300068Medicaid
ND1466615Medicaid