Healthcare Provider Details

I. General information

NPI: 1104917012
Provider Name (Legal Business Name): REUBEN V CUISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVENUE CAPITAL PATHOLOGY PC
LANSING MI
48912-1811
US

IV. Provider business mailing address

1215 E MICHIGAN AVENUE CAPITAL PATHOLOGY PC
LANSING MI
48912-1811
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-1000
  • Fax: 517-372-0581
Mailing address:
  • Phone: 517-364-1000
  • Fax: 517-372-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number087432
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: