Provider Demographics
NPI:1245296656
Name:KUSHNER, HAROLD C (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:C
Last Name:KUSHNER
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:PO BOX 7518
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33911-7518
Mailing Address - Country:US
Mailing Address - Phone:239-931-7262
Mailing Address - Fax:239-931-7382
Practice Address - Street 1:13691 METRO PKWY
Practice Address - Street 2:STE 420
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4327
Practice Address - Country:US
Practice Address - Phone:239-768-7332
Practice Address - Fax:239-768-2197
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42748207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040308300Medicaid
FL040001328OtherRAILROAD MEDICARE PROVIDER NUMBER
FL040001328OtherRAILROAD MEDICARE PROVIDER NUMBER
FL040308300Medicaid