Provider Demographics
NPI:1447236328
Name:STEVEN A KUSHNER DO PC
Entity Type:Organization
Organization Name:STEVEN A KUSHNER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KUSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-305-9614
Mailing Address - Street 1:3272 E 12 MILE RD. #106
Mailing Address - Street 2:DEERFIELD MEADOWS
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-5436
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. #106
Practice Address - Street 2:DEERFIELD MEADOWS
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-5436
Practice Address - Country:US
Practice Address - Phone:586-751-3650
Practice Address - Fax:586-751-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3014304 TYPE 11Medicaid
MI0P18600Medicare PIN