Individual
MR. GARY M PUSATERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3144 VANZILE RD, CRANDON, WI 54520-8149
(715) 478-5180
Mailing address
E23570 POW WOW TRAIL, WATERSMEET, MI 49969
(906) 358-4588
(906) 358-4588
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
29938-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31543400
—
WI
Enumeration date
08/18/2005
Last updated
05/18/2021
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