Provider Demographics
NPI:1679672430
Name:CUSHMAN, S. MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:S.
Middle Name:MARSHALL
Last Name:CUSHMAN
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 1:3831 LIGHTHOUSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402
Mailing Address - Country:US
Mailing Address - Phone:262-639-8925
Mailing Address - Fax:
Practice Address - Street 1:3805B SPRING ST STE 320
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-1644
Practice Address - Country:US
Practice Address - Phone:262-687-8322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14010207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B52268Medicare UPIN