Provider Demographics
NPI:1609510205
Name:GUSFA, DONALD WAYNE (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WAYNE
Last Name:GUSFA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PORTAGE ST # MI
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4929
Mailing Address - Country:US
Mailing Address - Phone:269-337-6361
Mailing Address - Fax:
Practice Address - Street 1:300 PORTAGE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4929
Practice Address - Country:US
Practice Address - Phone:269-337-6361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151015486390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program