MEDICARE: SHASHIDHAR KUSUMA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	35088257	OH
2	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	107122	FL
3	208200000X	Plastic Surgery Physician	107122	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598770430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHASHIDHAR KUSUMA M.D.

Provider Business Mailing Address
First Line	:	8430 W BROWARD BLVD
Second Line	:	SUITE 200
City	:	PLANTATION
State	:	FL
Zip	:	33324-2700
Country	:	US
Telephone Number	:	954-472-8355
Fax Number	:	954-472-8220

Provider Business Practice Location Address
First Line	:	8430 W BROWARD BLVD
Second Line	:	SUITE 200
City	:	PLANTATION
State	:	FL
Zip	:	33324-2700
Country	:	US
Telephone Number	:	954-472-8355
Fax Number	:	954-472-8220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	06/24/2010

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Directions to “ SHASHIDHAR KUSUMA M.D.” Practice Location

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