Healthcare Provider Details

I. General information

NPI: 1043437395
Provider Name (Legal Business Name): KEITH W CUSHING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1159 W JEFFERSON ST STE 206
FRANKLIN IN
46131-2795
US

IV. Provider business mailing address

6983 HILLSDALE CT
INDIANAPOLIS IN
46250-2054
US

V. Phone/Fax

Practice location:
  • Phone: 317-738-4430
  • Fax: 317-738-4405
Mailing address:
  • Phone: 317-849-8350
  • Fax: 317-576-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number01065032A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01065032A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: