Provider Demographics
NPI:1992932529
Name:BUSCH, RYAN SHEPARD (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SHEPARD
Last Name:BUSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12650 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-6201
Mailing Address - Country:US
Mailing Address - Phone:724-396-6614
Mailing Address - Fax:
Practice Address - Street 1:12650 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-6201
Practice Address - Country:US
Practice Address - Phone:724-396-6614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA26395671207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology