Basic Information
| Provider Information | |||||||||
| NPI: | 1164757514 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUSMANO | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 746723 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303746723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127339730 | ||||||||
| FaxNumber: | 7738668014 | ||||||||
| Practice Location | |||||||||
| Address1: | 1142 E 9 MILE RD | ||||||||
| Address2: | |||||||||
| City: | HAZEL PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480301901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488174742 | ||||||||
| FaxNumber: | 2485188719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2009 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 57-016039 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.