Individual
DR. RICHARD LANE KUSUNOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
40 SKOKIE BLVD STE 520, NORTHBROOK, IL 60062-1601
(847) 504-5000
(847) 504-5015
Mailing address
PO BOX 917, NORTHBROOK, IL 60065-0917
(847) 504-5000
(847) 504-5015
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016003981
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016003981
—
IL
01
—
480013283
MEDICARE - TRA
IL
01
—
600-01725
IL BC/BS
IL
Enumeration date
08/11/2005
Last updated
01/22/2019
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