Provider Demographics
NPI:1134128143
Name:SCHUSSLER, THOMAS S (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:SCHUSSLER
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 1:340 THOMAS MORE PKWY
Mailing Address - Street 2:STE 160A
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5100
Mailing Address - Country:US
Mailing Address - Phone:859-331-6466
Mailing Address - Fax:859-344-7930
Practice Address - Street 1:10600 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4463
Practice Address - Country:US
Practice Address - Phone:513-853-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41159207RG0100X
OH35086075207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100015420Medicaid
KYP00839851OtherRAILROAD MEDICARE
OH2573344Medicaid
KYP00416463OtherRAILROAD MEDICARE
KYP00839851OtherRAILROAD MEDICARE
KY7100015420Medicaid
KY0387732Medicare PIN