Provider Demographics
NPI:1609297894
Name:KUSHARE, INDRANIL
Entity Type:Individual
Prefix:
First Name:INDRANIL
Middle Name:
Last Name:KUSHARE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17580 INTERSTATE 45 S # FF4
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4972
Mailing Address - Country:US
Mailing Address - Phone:936-267-7200
Mailing Address - Fax:
Practice Address - Street 1:17580 INTERSTATE 45 S
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-4972
Practice Address - Country:US
Practice Address - Phone:936-267-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-15
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMTL001434207XP3100X
TXQ7407207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery