Individual
MATTHEW GARRETT CUSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016
(602) 263-1200
Mailing address
PO BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1200
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
41892
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
860904687
TAX ID
AZ
Enumeration date
05/22/2007
Last updated
05/02/2019
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