Organization
PROFESSIONAL OBGYN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER KUSHNER D.O. (PRESIDENT)
(248) 476-4900
Entity
Organization
Contact information
Practice address
55 N POND DR, SUITE 2, WALLED LAKE, MI 48390-3080
(248) 624-3366
(248) 624-0127
Mailing address
20276 MIDDLEBELT RD, SUITE 2, LIVONIA, MI 48152-2054
(248) 476-4900
(248) 476-5435
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H24970
BCBS
MI
Enumeration date
01/09/2007
Last updated
08/22/2020
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