Blandine B Bustamante, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

01042290A Issued in IN

Practice address

2200 Randallia Dr
Ft Wayne, IN 46805-4638

Phone

(260) 424-2195

NPI assigned

Nov 29, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Allied Hospital Pathologists, P.C.

  • Anatomic Pathology & Clinical Pathology Physician
  • Fort Wayne, IN
  • NPI 1831175389
  NPD
• Fort Wayne Medical Laboratory Corporation

  • Medical Laboratory Technician
  • Ft Wayne, IN
  • NPI 1285610733

  Anatomic Pathology & Clinical Pathology

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272499200000",
    "number": "1093799546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2458 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055406",
            "telephone_number": "260-424-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 RANDALLIA DR",
            "city": "FT WAYNE",
            "state": "IN",
            "postal_code": "468054638",
            "telephone_number": "260-424-2195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTAMANTE",
        "first_name": "BLANDINE",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-29",
        "last_updated": "2010-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IN",
            "license": "01042290A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200002580",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michela Angela Buss, MS, BCBA
• Ryan D Buss, MD
• Shilpa Subhash Buss, D.D.S
• Emily Bussick, SLP-CCC
• Timothy Jay Bussick, D.D.S; M.S.
• Amanda Nicole Butcher, MA, BCBA
• Joshua Charles Butcher, PT
• Kimberly J Butcher, MS
• Megan Butcher
• Alissa Lea Butler, BS

• Anatomic Pathology & Clinical Pathology Physician in Ft Wayne, IN
• Providers in Ft Wayne, IN by specialty
• Anatomic Pathology & Clinical Pathology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.