Individual
LISA LEE GUSHWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
935 HIGHLAND BLVD STE 2200, BOZEMAN, MT 59715-6915
(406) 414-5700
Mailing address
915 HIGHLAND BLVD, BOZEMAN, MT 59715-6902
(406) 414-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11969
MT
207Q00000X
Family Medicine Physician
34251
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
978992
—
AZ
01
—
P00457901
RAILROAD MEDICARE
AZ
Enumeration date
07/07/2006
Last updated
04/15/2025
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