Basic Information
| Provider Information | |||||||||
| NPI: | 1912007881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUSICK | ||||||||
| FirstName: | HOWARD | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7714 LAKEVIEW DR | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393059455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246740497 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1314 19TH AVE | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393014116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014830011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 02/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 0101240471 | VA | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 14799 | HI | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 21738 | MS | Y | Allopathic & Osteopathic Physicians | General Practice | 207P00000X | 21738 | MS | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.