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NPI Code Detail

MEDICARE: DR. DIANE MARIE KUSHNAR DO

MEDICARE: DR. DIANE MARIE KUSHNAR DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician34006625KOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1743136652OTHEROHCOMMERCIAL CARRIERS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4384812OTHEROHANTHEM PROVIDER NUMBER
55342673OTHEROHAETNA PROVIDER NUMBER

General Provider Information

NPI Number : 1659473858
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANE MARIE KUSHNAR DO
Provider Business Mailing Address
First Line : 1395 NW 167TH ST STE 120
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33169-5742
Country : US
Telephone Number : 216-294-4440
Fax Number :
Provider Business Practice Location Address
First Line : 5264 LEE RD
Second Line :
City : MAPLE HEIGHTS
State : OH
Zip : 44137-1232
Country : US
Telephone Number : 216-294-4440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2006
Last Update Date : 04/30/2021

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Directions to “ DR. DIANE MARIE KUSHNAR DO” Practice Location

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