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NPI Code Detail

MEDICARE: DR. SUSAN JOYCE CUSHMAN M.D.

MEDICARE: DR. SUSAN JOYCE CUSHMAN 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
1207VG0400XGynecology Physician30673MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740286400
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN JOYCE CUSHMAN M.D.
Provider Business Mailing Address
First Line : 14001 RIDGEDALE DR
Second Line : STE 200
City : MINNETONKA
State : MN
Zip : 55305-1753
Country : US
Telephone Number : 952-249-2000
Fax Number : 952-249-2099
Provider Business Practice Location Address
First Line : 14001 RIDGEDALE DR
Second Line : STE 200
City : MINNETONKA
State : MN
Zip : 55305-1753
Country : US
Telephone Number : 952-249-2000
Fax Number : 952-249-2099
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 04/30/2008

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