Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 01065032A | IN |
NPI | 1043437395 |
---|---|
Provider Name | Keith W Cushing |
First Address | Indianapolis, IN 46250-2054 |
Second Address | Franklin, IN 46131-2795 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200904510 | (05) | IN |