Healthcare Provider Details

I. General information

NPI: 1205802725
Provider Name (Legal Business Name): BURTON J KUSHNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 BLACKHAWK DR
MADISON WI
53705-1404
US

IV. Provider business mailing address

3416 BLACKHAWK DR
MADISON WI
53705-1404
US

V. Phone/Fax

Practice location:
  • Phone: 608-238-7733
  • Fax:
Mailing address:
  • Phone: 608-238-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number17307
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: