Organization
PROFESSIONAL OBGYN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER KUSHNER DO (PRESIDENT)
(248) 476-4900
Entity
Organization
Contact information
Practice address
20276 MIDDLEBELT RD, SUITE 2, LIVONIA, MI 48152-2054
(248) 476-4900
(248) 476-5435
Mailing address
20276 MIDDLEBELT RD STE 2, LIVONIA, MI 48152-2054
(248) 476-4900
(248) 476-5435
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H24970
BCBS GROUP PIN
MI
Enumeration date
12/28/2006
Last updated
08/15/2012
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