Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 669 | MN |
NPI | 1386609865 |
---|---|
Provider Name | Dr. Bradley Alan Mccusker |
First Address | Aitkin, MN 56431-1865 |
Second Address | Aitkin, MN 56431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 25/11/2020 |