Provider Demographics
NPI:1578513842
Name:KUSHNER, JAMES P (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:KUSHNER
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:PO BOX 581700
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84158-1700
Mailing Address - Country:US
Mailing Address - Phone:801-581-2121
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT151632-1205207R00000X, 207RH0000X, 207RH0003X, 207ZH0000X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT04211Medicaid
ID000052900Medicaid
MT0032793Medicaid
107005274101OtherIHC # 870442845
36608OtherDMBA # 870442845
PRA03743OtherMOLINA # 870442845
NV002088532Medicaid
870442845KU1OtherEMIA # 870442845
107005274H04OtherIHC HUNTSMAN # 870442845
UT111157015OtherRAILROAD MEDICARE
3000011OtherUNITED HEALTH CARE #
WY122118300Medicaid
1882OtherUNIVERSITY HEALTH PLANS #
1894OtherPEHP # 870442845
QM0000022835OtherALTIUS # 870442845
1894OtherPEHP # 870442845