Provider Demographics
NPI:1275577587
Name:HUSSON, CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:HUSSON
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 1:4255 BEECHER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3608
Mailing Address - Country:US
Mailing Address - Phone:810-232-3522
Mailing Address - Fax:810-762-4526
Practice Address - Street 1:4255 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3608
Practice Address - Country:US
Practice Address - Phone:810-232-3522
Practice Address - Fax:810-762-4526
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4162212Medicaid
MIH52641Medicare UPIN
MIN69170048Medicare ID - Type Unspecified