Provider Demographics
NPI:1891930749
Name:KUSHAWAHA, ANURAG SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANURAG
Middle Name:SINGH
Last Name:KUSHAWAHA
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 1:3365 BALTIC DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8680
Mailing Address - Country:US
Mailing Address - Phone:718-213-6136
Mailing Address - Fax:
Practice Address - Street 1:3365 BALTIC DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8680
Practice Address - Country:US
Practice Address - Phone:718-213-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109471207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFG231ZMedicare PIN