Provider Demographics
NPI:1083660344
Name:MUSSEMANN, FRANK F (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:F
Last Name:MUSSEMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 MCPHERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2822
Mailing Address - Country:US
Mailing Address - Phone:618-233-0017
Mailing Address - Fax:618-233-0251
Practice Address - Street 1:180 S 3RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1952
Practice Address - Country:US
Practice Address - Phone:618-233-0017
Practice Address - Fax:618-233-0251
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL272435OtherHEALTHLINK
IL12014V3948OtherGROUP HEALTH PLAN
IL8215125OtherBLUE CROSS BLUE SHIELD
IL036091400Medicaid
IL0707328OtherUHC MEDICARE COMPLETE
MO105469OtherALLIANCE BC/BS
IL160025736OtherRAILROAD MEDICARE
IL12014V3948OtherGROUP HEALTH PLAN
MO105469OtherALLIANCE BC/BS