Healthcare Provider Details

I. General information

NPI: 1588405484
Provider Name (Legal Business Name): CHRISTIAN DENNIS MCCUSKER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 CHARLES ST STE 300
ROCKFORD IL
61104-2200
US

IV. Provider business mailing address

5850 E STILL CIR
MESA AZ
85206-3618
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-5888
  • Fax:
Mailing address:
  • Phone: 847-532-5891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: