Provider Demographics
NPI:1073636809
Name:CUSICK, JAMES MICHAEL (MD FACEP)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:CUSICK
Suffix:
Gender:M
Credentials:MD FACEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10309 E LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5499
Mailing Address - Country:US
Mailing Address - Phone:303-779-6968
Mailing Address - Fax:303-221-1233
Practice Address - Street 1:10309 E LAKE DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-5499
Practice Address - Country:US
Practice Address - Phone:303-779-6968
Practice Address - Fax:303-221-1233
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27661207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01276617Medicaid
KS200716290AMedicaid
KS200716290AMedicaid
CO01276617Medicaid
KSKA1398033Medicare PIN