Individual
DOMINIC A CUSUMANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
28295 SCHOENHERR RD, STE C, WARREN, MI 48088-4300
(586) 573-6669
(586) 573-6667
Mailing address
28295 SCHOENHERR RD, STE C, WARREN, MI 48088-4300
(586) 573-6669
(586) 573-6667
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301407063
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E06364
BCBS
MI
Enumeration date
08/23/2005
Last updated
12/29/2020
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