MEDICARE: CHRISTIAN DENNIS MCCUSKER PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1588405484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN DENNIS MCCUSKER PA

Provider Business Mailing Address
First Line	:	5850 E STILL CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-3618
Country	:	US
Telephone Number	:	847-532-5891
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 CHARLES ST STE 300
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61104-2200
Country	:	US
Telephone Number	:	779-696-5888
Fax Number	:

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

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	05/07/2026

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