Individual
MICHAEL JOSEPH CUSATIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1507 S. OTSEGO, SUITE B, GAYLORD, MI 49735
(989) 732-4189
(989) 732-1916
Mailing address
1507 S. OTSEGO, SUITE B, GAYLORD, MI 49735
(989) 732-4189
(989) 732-1916
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D14500
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5190276
—
MI
01
—
56910090
BCBS ID #
MI
Enumeration date
07/19/2006
Last updated
11/04/2008
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