MEDICARE: ALEXANDER JAMES CUSMANO 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	207R00000X	Internal Medicine Physician	57-016039	OH

General Provider Information

NPI Number	:	1164757514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER JAMES CUSMANO MD

Provider Business Mailing Address
First Line	:	PO BOX 639295 DEPT 93394
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-9295
Country	:	US
Telephone Number	:	248-434-6169
Fax Number	:	855-618-6655

Provider Business Practice Location Address
First Line	:	500 KIRTS BLVD STE 100
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-4135
Country	:	US
Telephone Number	:	248-266-4200
Fax Number	:

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

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	02/02/2024

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