Provider Demographics
NPI:1902803562
Name:MCCUSKEY, WILLIAM HANES (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HANES
Last Name:MCCUSKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8005
Mailing Address - Country:US
Mailing Address - Phone:239-936-2316
Mailing Address - Fax:239-834-6106
Practice Address - Street 1:3680 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8005
Practice Address - Country:US
Practice Address - Phone:239-936-2316
Practice Address - Fax:239-834-6106
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1035412085R0202X
NC34395174400000X, 2085R0202X
VA01012451692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F29762Medicare UPIN
BM1534228OtherDEA
NC8901898Medicaid
NC7901897Medicaid
NC204307Medicare PIN
NC204302Medicare PIN