Provider Demographics
NPI:1679503270
Name:BUSH, MICHELLE L (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:526 MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3301
Mailing Address - Country:US
Mailing Address - Phone:978-371-7010
Mailing Address - Fax:978-737-1805
Practice Address - Street 1:22 MILL ST STE 304
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4778
Practice Address - Country:US
Practice Address - Phone:781-641-4900
Practice Address - Fax:978-244-2522
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA221250207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I36443Medicare UPIN