Provider Demographics
NPI:1861895831
Name:SUSHIL PUSKUR MD PA
Entity type:Organization
Organization Name:SUSHIL PUSKUR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PUSKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-369-3100
Mailing Address - Street 1:1740 SE 18TH ST
Mailing Address - Street 2:SUITE 802
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5408
Mailing Address - Country:US
Mailing Address - Phone:352-369-3100
Mailing Address - Fax:352-369-3101
Practice Address - Street 1:1740 SE 18TH ST
Practice Address - Street 2:SUITE 802
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5408
Practice Address - Country:US
Practice Address - Phone:352-369-3100
Practice Address - Fax:352-369-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 999632084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty