Louis Bustos
Individual provider Active NPI Athletic Trainer · Lagrange, IN
NPI 1982098752 · NPPES record last updated Mar 19, 2015
Key facts
- NPI
- 1982098752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 1105 E 250 N
Lagrange, IN 46761-9353 - Phone
- (260) 402-1775
- NPI assigned
- Mar 19, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
1105 E 250 N
Lagrange, IN 46761-9353
Mailing address
1105 E 250 N
Lagrange, IN 46761
Phone (260) 402-1775
Other providers in Lagrange, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.