Healthcare Provider Details

I. General information

NPI: 1558300814
Provider Name (Legal Business Name): KEVIN M DUSHAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST FL 3
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

2900 CORPORATE WAY STE D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-3565
  • Fax: 401-444-5493
Mailing address:
  • Phone: 954-276-5603
  • Fax: 954-985-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD11158
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD11158
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: