Provider Demographics
NPI:1962775122
Name:COUSINO, BRIAN JAMES (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:COUSINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 PATIENT CARE DR STE 108
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4276
Mailing Address - Country:US
Mailing Address - Phone:517-485-8217
Mailing Address - Fax:517-489-4980
Practice Address - Street 1:3960 PATIENT CARE DR STE 108
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4276
Practice Address - Country:US
Practice Address - Phone:517-485-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019958207RN0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty