Provider Demographics
NPI:1568090504
Name:KUSHNER, NECHEMIAH LEIB (CAA)
Entity Type:Individual
Prefix:MR
First Name:NECHEMIAH
Middle Name:LEIB
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:KUSHNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAA
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-8700
Mailing Address - Fax:414-259-1522
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-8700
Practice Address - Fax:414-259-1522
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
32697630367H00000X
WI160367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant