Provider Demographics
NPI:1043437395
Name:CUSHING, KEITH W (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:W
Last Name:CUSHING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6983 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2054
Mailing Address - Country:US
Mailing Address - Phone:317-849-8350
Mailing Address - Fax:317-576-6311
Practice Address - Street 1:1159 W JEFFERSON ST STE 206
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2795
Practice Address - Country:US
Practice Address - Phone:317-738-4430
Practice Address - Fax:317-738-4405
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2021-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01065032A2084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200904510Medicaid