Provider Demographics
NPI:1346276755
Name:KUSUMI, RODNEY K (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:K
Last Name:KUSUMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 BRYDEN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-5004
Mailing Address - Country:US
Mailing Address - Phone:614-461-3214
Mailing Address - Fax:614-621-4300
Practice Address - Street 1:685 BRYDEN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-5004
Practice Address - Country:US
Practice Address - Phone:614-461-3214
Practice Address - Fax:614-621-4300
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040086207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0462673Medicaid
OHA80157Medicare UPIN
OH0462673Medicaid