Provider Demographics
NPI:1962740621
Name:MARY D BUSH, MD,PC
Entity type:Organization
Organization Name:MARY D BUSH, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-704-1084
Mailing Address - Street 1:2160 W 86TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1907
Mailing Address - Country:US
Mailing Address - Phone:317-704-1084
Mailing Address - Fax:317-704-1087
Practice Address - Street 1:2160 W 86TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1907
Practice Address - Country:US
Practice Address - Phone:317-704-1084
Practice Address - Fax:317-704-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty