# PROFESSIONAL OBGYN PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477602480
- **Authorized official:** DR. ROGER KUSHNER D.O. (PRESIDENT)
- **Authorized official phone:** (248) 476-4900

## Contact information

- **Practice address:** 55 N POND DR, SUITE 2, WALLED LAKE, MI 48390-3080
- **Practice address phone:** (248) 624-3366
- **Practice address fax:** (248) 624-0127
- **Mailing address:** 20276 MIDDLEBELT RD, SUITE 2, LIVONIA, MI 48152-2054
- **Mailing address phone:** (248) 476-4900
- **Mailing address fax:** (248) 476-5435

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/09/2007
- **Last updated:** 08/22/2020