Healthcare Provider Details

I. General information

NPI: 1720046030
Provider Name (Legal Business Name): MEGAN A KUSHNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 N HIGH POINT RD DEAN MEDICAL CENTER
MADISON WI
53717-2236
US

IV. Provider business mailing address

752 N HIGH POINT RD DEAN MEDICAL CENTER
MADISON WI
53717-2236
US

V. Phone/Fax

Practice location:
  • Phone: 608-824-4800
  • Fax: 608-824-4910
Mailing address:
  • Phone: 608-824-4800
  • Fax: 608-824-4910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1617-023
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1617-023
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1617
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: