Provider Demographics
NPI:1568782761
Name:KUSHNER, MICHAEL CHARLES (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:101 W IRVINGTON RD
Mailing Address - Street 2:BUILDING #10
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-3050
Mailing Address - Country:US
Mailing Address - Phone:520-670-3909
Mailing Address - Fax:520-309-4576
Practice Address - Street 1:101 W IRVINGTON RD
Practice Address - Street 2:BUILDING #10
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-3050
Practice Address - Country:US
Practice Address - Phone:520-670-3909
Practice Address - Fax:520-309-4576
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125058266207Q00000X
AZ47144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine