Doctor Name: | MR. GARY M PUSATERI |
NPI Number: | 1851383525 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 29938-020 |
Business Practice Address: | E23570 Pow Wow Tr. Watersmeet, MI - 49969 |
Business Phone Number: | 9063584588 |
Business Fax Number: | 9063584588 |
Mailing Address: | E23570 Pow Wow Trail, WATERSMEET |
State: | MI |
Postal Code: | 49969 |
Phone Number: | 9063584588 |
Fax Number: | 9063584588 |
NPI Enumeration Date: | 08/18/2005 |
NPI Last Update Date: | 12/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 29938-020 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |