Provider Demographics
NPI:1982665691
Name:KAUSHAL, NINA (MD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:KAUSHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18697 BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3417
Mailing Address - Country:US
Mailing Address - Phone:440-816-8000
Mailing Address - Fax:
Practice Address - Street 1:30680 BAINBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44139-2282
Practice Address - Country:US
Practice Address - Phone:440-542-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-7991-K207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2387804Medicaid
OH2387804Medicaid
OHH77931Medicare UPIN