Provider Demographics
NPI:1164408985
Name:KUSHNER, STEVEN ALAN (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALAN
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3272 E 12 MILE RD STE 106
Mailing Address - Street 2:DEERFIELD MEADOWS
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-5622
Mailing Address - Country:US
Mailing Address - Phone:586-751-3650
Mailing Address - Fax:586-751-3505
Practice Address - Street 1:3272 E 12 MILE RD STE 106
Practice Address - Street 2:DEERFIELD MEADOWS
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-5622
Practice Address - Country:US
Practice Address - Phone:586-751-3650
Practice Address - Fax:586-757-3505
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2011-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MISK008923207XS0106X
MI989940225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101660OtherGREAT LAKES HEALTH PLAN
MI123081OtherPREFERRED CHOICES
MI3014304 TYPE 11Medicaid
MI123081OtherPRIORITY HEALTH
MI4242651OtherAETNA
MI5630294OtherBLUE CARE NETWORK
MI123081OtherCARE CHOICES
MI4242651OtherAETNA
MI5630294OtherBLUE CARE NETWORK