Provider Demographics
NPI:1528363124
Name:COUSINS, TODD ARTHUR (IDC)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:ARTHUR
Last Name:COUSINS
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 SADDLEBACK HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-1118
Mailing Address - Country:US
Mailing Address - Phone:719-310-3726
Mailing Address - Fax:
Practice Address - Street 1:5015 SADDLEBACK HTS
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-1118
Practice Address - Country:US
Practice Address - Phone:719-310-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman