MEDICARE: NESTOR S CUASAY 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	2085R0202X	Diagnostic Radiology Physician	036046110	IL

General Provider Information

NPI Number	:	1467450882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NESTOR S CUASAY MD

Provider Business Mailing Address
First Line	:	3849 N PERRYVILLE ROAD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114
Country	:	US
Telephone Number	:	708-361-2891
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 W TAYLOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-7232
Country	:	US
Telephone Number	:	312-996-0235
Fax Number	:

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	02/12/2019

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