Basic Information
Provider Information
NPI: 1467450882
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CUASAY
FirstName: NESTOR
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3849 N PERRYVILLE ROAD
Address2:  
City: ROCKFORD
State: IL
PostalCode: 61114
CountryCode: US
TelephoneNumber: 7083612891
FaxNumber:  
Practice Location
Address1: 1740 W TAYLOR ST
Address2:  
City: CHICAGO
State: IL
PostalCode: 606127232
CountryCode: US
TelephoneNumber: 3129960235
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/09/2005
LastUpdateDate: 02/12/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X036046110ILY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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