Provider Demographics
NPI:1386645851
Name:DONALD P. COUSINEAU DO PC
Entity Type:Organization
Organization Name:DONALD P. COUSINEAU DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:COUSINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-732-7843
Mailing Address - Street 1:994 N CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9375
Mailing Address - Country:US
Mailing Address - Phone:989-732-7843
Mailing Address - Fax:989-731-4513
Practice Address - Street 1:994 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9375
Practice Address - Country:US
Practice Address - Phone:989-732-7843
Practice Address - Fax:989-731-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDC006878208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1089781Medicaid
MI1089781Medicaid
0N86290Medicare ID - Type Unspecified