Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 0103301023 | VA |
N | 213ES0103X | Foot & Ankle Surgery | 5901002206 | MI |
NPI | 1104031731 |
---|---|
Provider Name | Dr. Paul Alexander Kushlak |
First Address | Winchester, VA 22601-3969 |
Second Address | Winchester, VA 22601-3969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 10/11/2009 |