MEDICARE: DR. SUSAN OSTBERG KUSHMAN MD

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	207P00000X	Emergency Medicine Physician	33027	KY

Other Identifiers

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

General Provider Information

NPI Number	:	1811998701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN OSTBERG KUSHMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 635283
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-5283
Country	:	US
Telephone Number	:	859-655-1100
Fax Number	:	859-655-1102

Provider Business Practice Location Address
First Line	:	1500 JAMES SIMPSON JR WAY
Second Line	:
City	:	COVINGTON
State	:	KY
Zip	:	41011-0801
Country	:	US
Telephone Number	:	859-655-1100
Fax Number	:	859-655-1102

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	09/18/2018

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