Individual
TERRY K KUSHNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
333 N MADISON, PROVENA ST JOSEPH MEDICAL CENTER, JOLIET, IL 60435
(815) 741-7200
(815) 741-7591
Mailing address
333 N MADISON, JOLIET, IL 60435
(815) 741-7200
(815) 741-7591
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
36061827
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36061827
—
IL
01
—
6124854000
DEPARTMENT OF LABOR
IL
01
—
9915352
BLUE SHIELD
IL
01
—
N288949
HARMONY
IL
Enumeration date
09/21/2006
Last updated
11/06/2007
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