Provider Demographics
NPI:1093779647
Name:CUSICK, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:CUSICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13011 S 104TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1508
Mailing Address - Country:US
Mailing Address - Phone:708-478-3600
Mailing Address - Fax:708-478-3552
Practice Address - Street 1:3231 EUCLID AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3471
Practice Address - Country:US
Practice Address - Phone:708-783-2055
Practice Address - Fax:708-783-2181
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036084799207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL060056549OtherRAILROAD MEDICARE KANKAKE
IL060042343OtherRAILROAD MEDICARE COOK
ILL68227OtherMEDICARE INDIVIDUAL PTAN
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILCG1672OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILL57370OtherMEDICARE INDIVIDUAL PTAN
ILCN2703OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL01621208OtherBLUECROSS BLUE SHIELD
IL036084799Medicaid
IL416810OtherMEDICARE GROUP PTAN
IL060053215OtherRAILROAD MEDICARE WILL
IL1508810086OtherGROUP NPI
IL236550OtherMEDICARE GROUP PTAN
ILL70143OtherMEDICARE INDIVIDUAL PTAN
IL236551OtherMEDICARE GROUP PTAN
G45852Medicare UPIN