Provider Demographics
NPI:1053491928
Name:KUSHNER, MATTHEW G (PHD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE ST SE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-273-8700
Mailing Address - Fax:
Practice Address - Street 1:2312 S 6TH ST
Practice Address - Street 2:SUITE F256 / 2B WEST
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1336
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP32712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6142167OtherMEDICA-PRIMARY
768210OtherARAZ
MNHP22345OtherHEALTH PARTNERS
MN157172OtherFAIRVIEW
MN6142167OtherMEDICA-CHOICE
MN8D928KUOtherBCBS
MN1012202OtherPREFERRED ONE
MN102795OtherU CARE