Provider Demographics
NPI:1134210370
Name:CUSATI, DANIEL A (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:CUSATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PEACEHEALTH SURGICAL SPECIALTIES
Mailing Address - Street 2:3355 RIVERBEND DR., SUITE 300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8803
Mailing Address - Country:US
Mailing Address - Phone:541-222-8333
Mailing Address - Fax:541-222-8320
Practice Address - Street 1:PEACEHEALTH SURGICAL SPECIALTIES
Practice Address - Street 2:3355 RIVERBEND DR., SUITE 300
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8803
Practice Address - Country:US
Practice Address - Phone:541-222-8333
Practice Address - Fax:541-222-8320
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD153434208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500634391Medicaid
MN188617000Medicaid
ORR159248Medicare PIN
MN188617000Medicaid
MN020002972Medicare PIN