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General NPI Number Information
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NPI Number | 1740930601
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Entity Type | Individual
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Provider Name | MICHAEL KUSHNER
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Gender | Male
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 40 E INDIANOLA AVE
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City | PHOENIX
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State | AZ
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Zip | 85012-2019
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Country | US
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Telephone | 480-660-5775
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 CHANNING WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7533
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 010654
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | OS20777
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 6161277
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License Number State | ID
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