Busdiecker, Kevin Wayne

Busdiecker, Kevin Wayne is an individual health care provider with primary practice located at 2500 Metro Health Drive , Cleveland OH 44109. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant, which is considered as his primary health care specialty. Busdiecker, Kevin Wayne can be contacted via phone (216) 778-5790.

Contact Information

Primary practice address
2500 Metro Health Drive Cleveland OH 44109
Phone: (216) 778-5790
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant 367H00000X 67-000036 Ohio

Profile Details

NPI number 1528073004
LBN Legal business name Busdiecker, Kevin Wayne
Credentials Associate of Arts (AA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 31st, 2006
Last updated Sep 21st, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528073004 NPPES
Ohio Other 414955 WELLCARE MEDICAID
Ohio Other 000000232158 WELLCARE MEDICAID
Ohio Other 0583328 WELLCARE MEDICAID
Ohio Other 9724074 WELLCARE MEDICAID
Ohio Other 000000515962 WELLCARE MEDICAID
Ohio Other 430037559 WELLCARE MEDICAID
Ohio MEDICAID 2739264 WELLCARE MEDICAID

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