Provider Demographics
NPI:1477970705
Name:KUSHNIR, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:KUSHNIR
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 1:2435 BEXLEY VILLAGE DR # 200
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-2721
Mailing Address - Country:US
Mailing Address - Phone:813-467-4771
Mailing Address - Fax:813-467-4783
Practice Address - Street 1:2435 BEXLEY VILLAGE DR # 200
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-2721
Practice Address - Country:US
Practice Address - Phone:813-467-4771
Practice Address - Fax:813-467-4783
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130960207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020789900Medicaid