Basic Information
| Provider Information | |||||||||
| NPI: | 1578513842 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUSHNER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 581700 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841581700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015812121 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 N MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841320001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015812121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 151632-1205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0000X | 151632-1205 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RH0003X | 151632-1205 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207ZH0000X | 151632-1205 | UT | N | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZP0101X | 151632-1205 | UT | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
ID Information
| ID | Type | State | Issuer | Description | 04211 | 05 | UT | MEDICAID | 000052900 | 05 | ID | MEDICAID | 0032793 | 05 | MT | MEDICAID | 107005274101 | 01 | IHC # 870442845 | OTHER | 36608 | 01 | DMBA # 870442845 | OTHER | PRA03743 | 01 | MOLINA # 870442845 | OTHER | 002088532 | 05 | NV | MEDICAID | 870442845KU1 | 01 | EMIA # 870442845 | OTHER | 107005274H04 | 01 | IHC HUNTSMAN # 870442845 | OTHER | 111157015 | 01 | UT | RAILROAD MEDICARE | OTHER | 3000011 | 01 | UNITED HEALTH CARE # | OTHER | 122118300 | 05 | WY | MEDICAID | 1882 | 01 | UNIVERSITY HEALTH PLANS # | OTHER | 1894 | 01 | PEHP # 870442845 | OTHER | QM0000022835 | 01 | ALTIUS # 870442845 | OTHER |