MEDICARE: GRACE ELIZABETH CUSH DO

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	390200000X	Student in an Organized Health Care Education/Training Program		OH

General Provider Information

NPI Number	:	1679416564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE ELIZABETH CUSH DO

Provider Business Mailing Address
First Line	:	2600 6TH ST SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-1702
Country	:	US
Telephone Number	:	330-363-6223
Fax Number	:	330-363-3877

Provider Business Practice Location Address
First Line	:	2600 6TH ST SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-1702
Country	:	US
Telephone Number	:	330-363-6223
Fax Number	:	330-363-3877

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

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “ GRACE ELIZABETH CUSH DO” Practice Location

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