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General NPI Number Information
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NPI Number | 1851388490
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Entity Type | Individual
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Provider Name | ROBERT L CUSIC MD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 33 9TH ST W
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City | DICKINSON
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State | ND
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Zip | 58601-3950
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Country | US
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Telephone | 701-483-6017
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Fax | 701-483-5018
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Provider Business Mailing Address
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Address Line | 629 10TH AVE W
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City | DICKINSON
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State | ND
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Zip | 58601-4750
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Country | US
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Telephone | 701-483-8799
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 4877
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License Number State | ND
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