Healthcare Provider Details

I. General information

NPI: 1326067794
Provider Name (Legal Business Name): LAWRENCE G. KUSHINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 N MILITARY TRL
RIVIERA BEACH FL
33410-7417
US

IV. Provider business mailing address

10305 SAND CAY LN
WEST PALM BEACH FL
33412-3004
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-6387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number25MA05727400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: