Healthcare Provider Details

I. General information

NPI: 1467316430
Provider Name (Legal Business Name): TIA MARIA CUSHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIA MARIA MCCAULEY

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HOBART ST
CADILLAC MI
49601-2331
US

IV. Provider business mailing address

7353 CLAREOLA AVE
LAKE MI
48632-9550
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704399501
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: