MEDICARE: DR. THERESE ELIZABETH CUSICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	0427649	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043217722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESE ELIZABETH CUSICK MD

Provider Business Mailing Address
First Line	:	551 N HILLSIDE ST STE 201
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67214-4925
Country	:	US
Telephone Number	:	316-263-0296
Fax Number	:	316-263-9523

Provider Business Practice Location Address
First Line	:	9350 E 35TH ST N STE 103
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67226-2022
Country	:	US
Telephone Number	:	316-858-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/02/2026

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