Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 35973 | CO |
N | 2080P0208X | Pediatric Infectious Diseases | 35973 | CO |
NPI | 1558314872 |
---|---|
Provider Name | Michael Kuskie |
First Address | Colorado Springs, CO 80907-4090 |
Second Address | Colorado Springs, CO 80907-4090 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 05/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01359736 | (05) | CO |
G51974 | (02) | CO |