Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036101779 | IL |
Y | 111NI0900X | Internist | 036101779 | IL |
N | 207RA0401X | Internist - Addiction Medicine | 036101779 | IL |
NPI | 1053341487 |
---|---|
Provider Name | Dr. David Kushner |
First Address | Deerfield, IL 60015-3412 |
Second Address | Park Ridge, IL 60068-1143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 13/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H33038 | (02) | IL |