| Michael J. Cusatis Dds Pllc | |
|
1507 S Otsego Ave Ste B Gaylord MI 49735-9524 | |
| (989) 732-4189 | |
| (989) 732-1916 |
| Full Name | Michael J. Cusatis Dds Pllc |
|---|---|
| Speciality | Dentist |
| Location | 1507 S Otsego Ave Ste B, Gaylord, Michigan |
| Authorized Official Name and Position | Michael J. Cusatis (OWNER) |
| Authorized Official Contact | 9897324189 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael J. Cusatis Dds Pllc 1507 S Otsego Ave Ste B Gaylord MI 49735-9524 Ph: (989) 732-4189 | Michael J. Cusatis Dds Pllc 1507 S Otsego Ave Ste B Gaylord MI 49735-9524 Ph: (989) 732-4189 |
| NPI Number | 1518118454 |
|---|---|
| Provider Enumeration Date | 10/09/2008 |
| Last Update Date | 11/04/2008 |
| Medicare PECOS PAC ID | 1254491020 |
|---|---|
| Medicare Enrollment ID | O20081124000542 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518118454 | NPI | - | NPPES |
| 5190276 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | D14500 (Michigan) | Primary |
| Provider Name | Michael J Cusatis |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1700805652 PECOS PAC ID: 1456411776 Enrollment ID: I20081117000556 |
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