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NPI Code Detail

MEDICARE: MRS. ANGELA M CUSH-JOHN M.D.

MEDICARE:  MRS. ANGELA M CUSH-JOHN  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
1208000000XPediatrics Physician0822590LA

General Provider Information

NPI Number : 1922007129
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELA M CUSH-JOHN M.D.
Provider Business Mailing Address
First Line : 2225 LINE AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-2128
Country : US
Telephone Number : 318-221-2225
Fax Number : 318-459-2955
Provider Business Practice Location Address
First Line : 2225 LINE AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-2128
Country : US
Telephone Number : 318-221-2225
Fax Number : 318-459-2955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 07/08/2007

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Directions to “ MRS. ANGELA M CUSH-JOHN M.D.” Practice Location

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