Provider Demographics
NPI:1952367146
Name:KUSMA, MICHAEL J (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:KUSMA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8775 NORWIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2718
Mailing Address - Country:US
Mailing Address - Phone:724-864-8491
Mailing Address - Fax:
Practice Address - Street 1:8775 NORWIN AVE
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2718
Practice Address - Country:US
Practice Address - Phone:724-864-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001581L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S94711Medicare UPIN
034033Medicare ID - Type Unspecified