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Individual

DR. J DOUGLAS CUSICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4601 COLLEGE BLVD, SUITE 222, LEAWOOD, KS 66211
(913) 661-0202
(913) 661-0584
Mailing address
4601 COLLEGE BLVD, SUITE 222, LEAWOOD, KS 66211
(913) 661-0202
(913) 661-0584

Taxonomy

Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
0423923
KS
208200000X
Plastic Surgery Physician
MD100181
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100458460A
KS
01
21177020
BLUE SHIELD IND #
MO
Enumeration date
08/30/2006
Last updated
07/15/2008
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