Healthcare Provider Details

I. General information

NPI: 1558314872
Provider Name (Legal Business Name): MICHAEL KUSKIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 CENTENNIAL BLVD SUITE 205
COLORADO SPRINGS CO
80907-4090
US

IV. Provider business mailing address

3470 CENTENNIAL BLVD SUITE 205
COLORADO SPRINGS CO
80907-4090
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-4588
  • Fax: 719-594-4067
Mailing address:
  • Phone: 719-598-4588
  • Fax: 719-594-4067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35973
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number35973
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: