MEDICARE: RIDGEPARK FAMILY PRACTICE

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	261Q00000X	Clinic/Center

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

General Provider Information

NPI Number	:	1932386919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDGEPARK FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	5500 RIDGE ROAD
Second Line	:	SUITE 120
City	:	PARMA
State	:	OH
Zip	:	44129
Country	:	US
Telephone Number	:	216-398-5535
Fax Number	:	440-882-3304

Provider Business Practice Location Address
First Line	:	5500 RIDGE ROAD
Second Line	:	SUITE 120
City	:	PARMA
State	:	OH
Zip	:	44129-2367
Country	:	US
Telephone Number	:	216-398-5535
Fax Number	:	440-882-3304

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. DIANE MARIE KUSHNAR
Credential	:	DO
Telephone Number	:	216-398-5535

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	02/17/2012

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Directions to “RIDGEPARK FAMILY PRACTICE ” Practice Location

Language	Start Address	Practice Location

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