Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2017019509 | MO |
Y | 208600000X | Surgeon | 2017019509 | MO |
NPI | 1003336934 |
---|---|
Provider Name | Dr. Bradley Kushner |
First Address | Saint Louis, MO 63108-2872 |
Second Address | Saint Louis, MO 63110-1010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2017 |
Last Update Date | 21/06/2017 |