Basic Information
| Provider Information | |||||||||
| NPI: | 1497705974 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUI | ||||||||
| FirstName: | DON | ||||||||
| MiddleName: | JEFFERY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2871 W SUGNET RD | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896338000 | ||||||||
| FaxNumber: | 9896338172 | ||||||||
| Practice Location | |||||||||
| Address1: | 3009 N SAGINAW RD | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486404555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896331350 | ||||||||
| FaxNumber: | 9896331360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 05/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 385000241 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1497705974 | 01 | IL | NPI | OTHER | S87782 | 01 | IL | UPIN | OTHER | MC0729977 | 01 | IL | DEA | OTHER |