Provider Demographics
NPI:1053016444
Name:BUSH, MICAELA ERIN (DO)
Entity type:Individual
Prefix:DR
First Name:MICAELA
Middle Name:ERIN
Last Name:BUSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5935 OAKFORGE LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1269
Mailing Address - Country:US
Mailing Address - Phone:606-939-1539
Mailing Address - Fax:
Practice Address - Street 1:5935 OAKFORGE LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1269
Practice Address - Country:US
Practice Address - Phone:606-939-1539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program