Patrick Micheal Cusack, DMD,MSD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Practice address

1324 W. Northmoor Rd.
Peoria, IL 61614

Phone

(309) 693-3200

Fax

(309) 693-2499

NPI assigned

Apr 27, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073733275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1324 W NORTHMOOR RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143470",
            "telephone_number": "309-693-3200",
            "fax_number": "309-693-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1324 W. NORTHMOOR RD.",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "309-693-3200",
            "fax_number": "309-693-2499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSACK",
        "first_name": "PATRICK",
        "middle_name": "MICHEAL",
        "name_prefix": "Dr.",
        "credential": "DMD,MSD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan M Cunningham, PA-C
• Jay Michael Curley, LMFT, MSMFT, LPHA
• Keri Lynn Currier, ATC
• Debra L Curry, PTA
• Andrew Cusack, DO
• Thomas Cusack
• Colleen Susanne Cushing Ragon, APN, CNS
• Troy S Cutler, M.D.
• Jarema Sczesny Czarnecki, DO
• D & D Services, Inc.

• Orthodontics and Dentofacial Orthopedics Dentistry in Peoria, IL
• Providers in Peoria, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.