Provider Demographics
NPI:1841379260
Name:CHUSID, RONALD CRAIG (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CRAIG
Last Name:CHUSID
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 1:1762 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-2407
Mailing Address - Country:US
Mailing Address - Phone:231-773-3258
Mailing Address - Fax:231-773-4776
Practice Address - Street 1:1762 OAK AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-2407
Practice Address - Country:US
Practice Address - Phone:231-773-3258
Practice Address - Fax:231-773-4776
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI008174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5613832OtherBCBS PROVIDER CODE
MI1670147Medicaid
MI5613832Medicare ID - Type UnspecifiedMEDICARE
MI5613832OtherBCBS PROVIDER CODE