MEDICARE: DR. JUNGSIL K CUSIMANO 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	218013	NY
2	207R00000X	Internal Medicine Physician	ME116857	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	HK147Z	OTHER	FL	PTAN

General Provider Information

NPI Number	:	1821084740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUNGSIL K CUSIMANO MD

Provider Business Mailing Address
First Line	:	3608 BALLASTONE DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-8069
Country	:	US
Telephone Number	:	607-206-2007
Fax Number	:

Provider Business Practice Location Address
First Line	:	3608 BALLASTONE DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-8069
Country	:	US
Telephone Number	:	607-206-2007
Fax Number	:

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	12/09/2019

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