Provider Demographics
NPI:1740362359
Name:KUSMAN, BARRY (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:KUSMAN
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 1:1745 E SKYLINE DR STE 175
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1163
Mailing Address - Country:US
Mailing Address - Phone:520-742-5500
Mailing Address - Fax:520-742-1170
Practice Address - Street 1:1745 E SKYLINE DR STE 175
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-1163
Practice Address - Country:US
Practice Address - Phone:520-742-1900
Practice Address - Fax:520-742-1170
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12771207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ239112Medicaid
C99820Medicare UPIN
70471Medicare ID - Type Unspecified