Healthcare Provider Details

I. General information

NPI: 1265400378
Provider Name (Legal Business Name): ERIC CUASAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E STATE ST
ROCKFORD IL
61104-2315
US

IV. Provider business mailing address

1401 E STATE ST
ROCKFORD IL
61104-2315
US

V. Phone/Fax

Practice location:
  • Phone: 815-489-4760
  • Fax:
Mailing address:
  • Phone: 815-489-4760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-107125
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: