Provider Demographics
NPI:1811998701
Name:KUSHMAN, SUSAN OSTBERG (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:OSTBERG
Last Name:KUSHMAN
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-655-1100
Mailing Address - Fax:859-655-1102
Practice Address - Street 1:1500 JAMES SIMPSON JR WAY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-0801
Practice Address - Country:US
Practice Address - Phone:859-655-1100
Practice Address - Fax:859-655-1102
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33027207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64056013Medicaid
IN200916670Medicaid
OH2016295Medicaid
OH2016295Medicaid
KY3313203Medicare PIN
930109676Medicare PIN
KY64056013Medicaid
KY0969408Medicare PIN
H15955Medicare UPIN