Provider Demographics
NPI:1831132745
Name:KUSHEL, STEVEN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
Last Name:KUSHEL
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 1:1425 LIDA ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1919
Mailing Address - Country:US
Mailing Address - Phone:626-744-9868
Mailing Address - Fax:
Practice Address - Street 1:1425 LIDA ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1919
Practice Address - Country:US
Practice Address - Phone:626-744-9868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA41816207P00000X
WAMD60937815207P00000X
PAMD040748L207PE0004X
CAA49642207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A496420Medicaid
CAE88199Medicare UPIN
CA00A496423Medicare PIN
CAWA49642Medicare PIN
CA00A496420Medicare PIN
CA00A496422Medicare PIN
PA031629LQVMedicare PIN
CA00A496421Medicare PIN