Provider Demographics
NPI:1104031731
Name:KUSHLAK, PAUL ALEXANDER (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALEXANDER
Last Name:KUSHLAK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:117 N BRADDOCK ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3969
Mailing Address - Country:US
Mailing Address - Phone:540-662-4572
Mailing Address - Fax:540-722-9519
Practice Address - Street 1:117 N BRADDOCK ST
Practice Address - Street 2:SUITE 150
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3969
Practice Address - Country:US
Practice Address - Phone:540-662-4572
Practice Address - Fax:540-722-9519
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002206213ES0103X
VA0103301023213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery