Provider Demographics
NPI:1831674761
Name:ROGER KUSHNER DO P.C.
Entity Type:Organization
Organization Name:ROGER KUSHNER DO P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-626-4513
Mailing Address - Street 1:32406 FRANKLIN RD UNIT 250460
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-7019
Mailing Address - Country:US
Mailing Address - Phone:248-626-4513
Mailing Address - Fax:248-626-1474
Practice Address - Street 1:5391 TERENCE CT
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-2555
Practice Address - Country:US
Practice Address - Phone:248-626-4513
Practice Address - Fax:248-626-1474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty