Provider Information for 1548285158
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Mr. MICHAEL DEAN GUSACK LPC
Sex: Male
NPI: 1548285158
Last Updated: 2020-05-27
Certification Date: 2020-05-27
Certification Date: 2020-05-27
Details
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NPI | 1548285158 | ||||||||
Enumeration Date | 2006-07-13 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 645 ELDORADO BLVD APT 1213 BROOMFIELD, CO 80021-8835 United States Phone: 850-737-0022 | Fax: | ||||||||
Primary Practice Address | 645 ELDORADO BLVD APT 1213 BROOMFIELD, CO 80021-8835 United States Phone: 850-737-0022 | Fax: | ||||||||
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