Bush, Shane David
Bush, Shane David is an sole proprietor health care provider with primary practice located at 3630 Willowcreek Rd , Portage IN 46368-5075. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Bush, Shane David can be contacted via phone (219) 364-3700.Contact Information
Primary practice address
3630 Willowcreek Rd
Portage IN 46368-5075
Phone: (219) 364-3700
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 01071914A | Indiana |
Profile Details
| NPI number | 1316258874 |
|---|---|
| LBN Legal business name | Bush, Shane David |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 29th, 2010 |
| Last updated | Jun 2nd, 2015 - about 10 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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