Basic Information
| Provider Information | |||||||||
| NPI: | 1043483134 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUSICK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7401 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770304509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137992300 | ||||||||
| FaxNumber: | 2815015900 | ||||||||
| Practice Location | |||||||||
| Address1: | 22751 PROFESSIONAL DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | KINGWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773396028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137992300 | ||||||||
| FaxNumber: | 2815015900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2008 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Q1808 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | Q1808 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
No ID Information.