Provider Demographics
NPI:1558314872
Name:KUSKIE, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KUSKIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3470 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4090
Mailing Address - Country:US
Mailing Address - Phone:719-598-4588
Mailing Address - Fax:719-594-4067
Practice Address - Street 1:3470 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4090
Practice Address - Country:US
Practice Address - Phone:719-598-4588
Practice Address - Fax:719-594-4067
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO35973208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01359736Medicaid
COG51974Medicare UPIN