Healthcare Provider Details

I. General information

NPI: 1740445782
Provider Name (Legal Business Name): STANLEY CARL USHINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5160 NORTH CAMINO SUMO
TUCSON AZ
85718-6044
US

IV. Provider business mailing address

5160 NORTH CAMINO SUMO
TUCSON AZ
85718-6044
US

V. Phone/Fax

Practice location:
  • Phone: 520-615-1008
  • Fax: 520-615-3366
Mailing address:
  • Phone: 520-615-1008
  • Fax: 520-615-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD009978E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25839
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: