Mccusker, Martha L

Mccusker, Martha L is an individual health care provider with primary practice located at 701 Park Ave , Minneapolis MN 55415-1623. She recently has only one registered license in Allopathic & Osteopathic Physicians / Geriatric Medicine, which is considered as her primary health care specialty. Mccusker, Martha L can be contacted via phone (612) 873-2723.

Contact Information

Primary practice address
701 Park Ave Minneapolis MN 55415-1623
Phone: (612) 873-2723
Fax: (612) 904-4243
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X 31121 Minnesota

Profile Details

NPI number 1184671836
LBN Legal business name Mccusker, Martha L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 28th, 2006
Last updated Oct 3rd, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184671836 NPPES
Minnesota MEDICAID 456093100

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