MEDICARE: DR. MARK JOSEPH JUSKA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	4301090568	MI
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	4301090568	MI

General Provider Information

NPI Number	:	1942439567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK JOSEPH JUSKA M.D.

Provider Business Mailing Address
First Line	:	5555 GLENWOOD HILLS PKWY SE STE 2
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49512-2091
Country	:	US
Telephone Number	:	616-940-2662
Fax Number	:	616-940-1965

Provider Business Practice Location Address
First Line	:	1675 E MOUNT GARFIELD RD STE 135
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49444-7732
Country	:	US
Telephone Number	:	231-799-8880
Fax Number	:	231-799-8803

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	05/04/2021

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