Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 21690 | NE |
NPI | 1295793800 |
---|---|
Provider Name | Dr. Robert A Cusick |
First Address | Omaha, NE 68114-4113 |
Second Address | Omaha, NE 68114-4113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01053 | BCBS (01) | NE |
233164 | MIDLANDS CHOICE (01) | |
3543934 | (05) | IA |
H44503 | (02) | NE |