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NPI Code Detail

MEDICARE: DON L CUSTODIO MD

MEDICARE: DON L CUSTODIO 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
1207P00000XEmergency Medicine Physician4301085609MI
2207P00000XEmergency Medicine Physician3088WI

General Provider Information

NPI Number : 1316152598
Entity Type Code : Individual
Provider Name (Legal Business Name) : DON L CUSTODIO MD
Provider Business Mailing Address
First Line : 1000 N OAK AVE
Second Line :
City : MARSHFIELD
State : WI
Zip : 54449-5703
Country : US
Telephone Number : 715-387-5511
Fax Number :
Provider Business Practice Location Address
First Line : 4100 STATE HIGHWAY 66
Second Line :
City : STEVENS POINT
State : WI
Zip : 54482-8410
Country : US
Telephone Number : 715-343-7700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2007
Last Update Date : 02/19/2024

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Directions to “ DON L CUSTODIO MD” Practice Location

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