Provider Demographics
NPI:1508347204
Name:DAVID KUSHNER DO PC
Entity Type:Organization
Organization Name:DAVID KUSHNER DO PC
Other - Org Name:BRIGHTSIDE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-205-7868
Mailing Address - Street 1:333 SKOKIE BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1624
Mailing Address - Country:US
Mailing Address - Phone:224-205-7866
Mailing Address - Fax:
Practice Address - Street 1:161 S LINCOLNWAY STE 312
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1662
Practice Address - Country:US
Practice Address - Phone:630-405-5089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID KUSHNER DO PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-22
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)