Provider Demographics
NPI:1992793384
Name:PUSHKA, ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:PUSHKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7369 SHERIDAN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2776
Mailing Address - Country:US
Mailing Address - Phone:954-983-5330
Mailing Address - Fax:954-983-5086
Practice Address - Street 1:7369 SHERIDAN ST STE 203
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2776
Practice Address - Country:US
Practice Address - Phone:954-983-5330
Practice Address - Fax:954-983-5086
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-024772084P0800X, 2084P0804X
FLME886662084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107645400Medicaid
FL004704500OtherGROUP MEDICAID NUMBER
FL004704500OtherGROUP MEDICAID NUMBER
FLU3780OtherMEDICARE PTAN
FLU3780XOtherMEDICARE PTAN
FL004704500OtherGROUP MEDICAID NUMBER