Provider Demographics
NPI:1477611002
Name:KUSHNER, PAUL GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GEORGE
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7743 OCEAN SUNSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6959
Mailing Address - Country:US
Mailing Address - Phone:561-642-9547
Mailing Address - Fax:561-642-9547
Practice Address - Street 1:7743 OCEAN SUNSET DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE WORH
Practice Address - State:FL
Practice Address - Zip Code:33467-6959
Practice Address - Country:US
Practice Address - Phone:561-642-9547
Practice Address - Fax:561-642-9547
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3246207Q00000X
PAOS2153L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
834216Medicare UPIN
041724R53Medicare ID - Type Unspecified