MEDICARE: AMRITA KUSHAL M.D.

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
1	207RC0000X	Cardiovascular Disease Physician	036155170	IL

General Provider Information

NPI Number	:	1679898746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMRITA KUSHAL M.D.

Provider Business Mailing Address
First Line	:	2740 W FOSTER AVE STE 412
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3532
Country	:	US
Telephone Number	:	773-293-4362
Fax Number	:	847-763-8932

Provider Business Practice Location Address
First Line	:	2740 W FOSTER AVE STE 412
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3532
Country	:	US
Telephone Number	:	773-293-4362
Fax Number	:	847-763-8932

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2010
Last Update Date	:	06/01/2022

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