Provider Demographics
NPI:1841485133
Name:COUSINEAU, DONALD PAUL (DO, PC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:PAUL
Last Name:COUSINEAU
Suffix:
Gender:M
Credentials:DO, PC
Other - Prefix:DR
Other - First Name:DONALD
Other - Middle Name:P
Other - Last Name:COUSINEAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO, PC
Mailing Address - Street 1:994 N CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDC006878208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1089781Medicaid
MIB46834Medicare UPIN
MI1089781Medicaid