Provider Demographics
NPI:1538258652
Name:KUSHNIR, MICHELLE LECHER (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LECHER
Last Name:KUSHNIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:100 E SYBELIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4748
Practice Address - Country:US
Practice Address - Phone:407-636-6520
Practice Address - Fax:407-636-6525
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-00574208000000X
VA0101236820208D00000X
FLME130076208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918806Medicaid
NCNC0518AMedicare UPIN