Provider Demographics
NPI:1801855234
Name:CUSICK, RALPH J JR (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:J
Last Name:CUSICK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 EAST OGDEN AVENUE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3655
Mailing Address - Country:US
Mailing Address - Phone:630-325-8893
Mailing Address - Fax:632-325-8939
Practice Address - Street 1:201 EAST OGDEN AVENUE
Practice Address - Street 2:SUITE 116
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3655
Practice Address - Country:US
Practice Address - Phone:630-325-8893
Practice Address - Fax:632-325-8939
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360733292084P0800X
IL036-0733292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036073329Medicaid
ILL37588Medicare UPIN
L37588Medicare UPIN
IL368820Medicare PIN