Healthcare Provider Details

I. General information

NPI: 1962775122
Provider Name (Legal Business Name): BRIAN JAMES COUSINO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 PATIENT CARE DR STE 108
LANSING MI
48911-4276
US

IV. Provider business mailing address

3960 PATIENT CARE DR STE 108
LANSING MI
48911-4276
US

V. Phone/Fax

Practice location:
  • Phone: 517-485-8217
  • Fax:
Mailing address:
  • Phone: 517-485-8217
  • Fax: 517-489-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number5101019958
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: