MEDICARE: ROGER KUSHNER DO P.C.

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1831674761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGER KUSHNER DO P.C.

Provider Business Mailing Address
First Line	:	32406 FRANKLIN RD UNIT 250460
Second Line	:
City	:	FRANKLIN
State	:	MI
Zip	:	48025-7019
Country	:	US
Telephone Number	:	248-626-4513
Fax Number	:	248-626-1474

Provider Business Practice Location Address
First Line	:	5391 TERENCE CT
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-2555
Country	:	US
Telephone Number	:	248-626-4513
Fax Number	:	248-626-1474

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROGER M KUSHNER
Credential	:	DO
Telephone Number	:	248-626-4513

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	09/26/2018

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