Individual
DR. PATRICK MICHEAL CUSACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD,MSD
Contact information
Practice address
1324 W. NORTHMOOR RD., PEORIA, IL 61614
(309) 693-3200
(309) 693-2499
Mailing address
1324 W NORTHMOOR RD, PEORIA, IL 61614-3470
(309) 693-3200
(309) 693-2499
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
IL
Other
Enumeration date
04/27/2007
Last updated
07/08/2007
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