Healthcare Provider Details

I. General information

NPI: 1063405108
Provider Name (Legal Business Name): JORGE A KUSNIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 537N
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

807 S ORLANDO AVE SUITE C
WINTER PARK FL
32789-4870
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-4693
  • Fax: 407-896-0569
Mailing address:
  • Phone: 407-894-4693
  • Fax: 407-539-0469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME0067778
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: