Organization
J DOUGLAS CUSICK, MD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. J DOUGLAS CUSICK MD (OWNER)
(913) 661-9537
Entity
Organization
Contact information
Practice address
4601 COLLEGE BLVD, SUITE 222, OVERLAND PARK, KS 66211-1650
(913) 661-0202
(913) 661-0584
Mailing address
4601 COLLEGE BLVD, SUITE 222, OVERLAND PARK, KS 66211-1650
(913) 661-0202
(913) 661-0584
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
100181
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27458015
BCBS GROUP #
MO
Enumeration date
08/29/2007
Last updated
03/11/2021
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