Provider Demographics
NPI:1922095876
Name:CUSHNER, STEPHEN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALAN
Last Name:CUSHNER
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 1:4711 E FALCON DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-2593
Mailing Address - Country:US
Mailing Address - Phone:480-357-2048
Mailing Address - Fax:
Practice Address - Street 1:4711 E FALCON DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2593
Practice Address - Country:US
Practice Address - Phone:480-357-2048
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19809208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A26071Medicare UPIN
75783Medicare ID - Type Unspecified