Provider Demographics
NPI:1134318827
Name:MICHAEL MUSCATELLA LTD
Entity Type:Organization
Organization Name:MICHAEL MUSCATELLA LTD
Other - Org Name:FAMILY FOOT & ANKLE CENTER OF CHAMPAIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSCATELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:217-398-3338
Mailing Address - Street 1:3125 VILLAGE OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-7673
Mailing Address - Country:US
Mailing Address - Phone:217-398-3338
Mailing Address - Fax:217-398-4961
Practice Address - Street 1:3125 VILLAGE OFFICE PL
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-7673
Practice Address - Country:US
Practice Address - Phone:217-398-3338
Practice Address - Fax:217-398-4961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004109213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC3185OtherRAILROAD MEDICARE
IL209968Medicare PIN
DC3185OtherRAILROAD MEDICARE