Provider Demographics
NPI:1538171160
Name:COWELL-KUSAK, KRISTI MICHELLE (MD)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:MICHELLE
Last Name:COWELL-KUSAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTI
Other - Middle Name:MICHELLE
Other - Last Name:COWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1850 ELDORADO DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3101 RIDGE RD W
Practice Address - Street 2:BLDG C
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3249
Practice Address - Country:US
Practice Address - Phone:585-225-1700
Practice Address - Fax:585-225-1439
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235873208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02865956Medicaid
NY02865956Medicaid