Provider Demographics
NPI:1720046030
Name:KUSHNER, MEGAN A (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:KUSHNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 N HIGH POINT RD
Mailing Address - Street 2:DEAN MEDICAL CENTER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2236
Mailing Address - Country:US
Mailing Address - Phone:608-824-4800
Mailing Address - Fax:608-824-4910
Practice Address - Street 1:752 N HIGH POINT RD
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2236
Practice Address - Country:US
Practice Address - Phone:608-824-4800
Practice Address - Fax:608-824-4910
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1617-023363AM0700X, 363AS0400X
WI1617363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1720046030Medicaid
WI41978000Medicaid
WI41978000Medicaid
WIP00338376Medicare PIN
P97743Medicare UPIN
WI011757085Medicare PIN