Individual
JEREMIAH BACALSO DUCUSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(586) 263-2300
Mailing address
50083 MARGARET AVE, MACOMB, MI 48044-6340
(586) 412-0838
(586) 412-0838
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
01/12/2022
Last updated
01/12/2022
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