Provider Demographics
NPI:1184695157
Name:KUSHNER, STEPHEN (DPM)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:MR
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:KUSHNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:4240 GALT OCEAN DR APT 903
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-6182
Mailing Address - Country:US
Mailing Address - Phone:954-922-7333
Mailing Address - Fax:954-922-4842
Practice Address - Street 1:10446 TAFT ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2819
Practice Address - Country:US
Practice Address - Phone:954-316-0504
Practice Address - Fax:954-431-5003
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0001947213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT96232Medicare UPIN
FL65133VMedicare ID - Type Unspecified