Provider Demographics
NPI:1275897019
Name:MUSETE, MONICA B (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:B
Last Name:MUSETE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 S 16TH ST STE 1020
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4532
Mailing Address - Country:US
Mailing Address - Phone:414-643-7337
Mailing Address - Fax:414-643-1766
Practice Address - Street 1:3201 S 16TH ST STE 1020
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4532
Practice Address - Country:US
Practice Address - Phone:414-643-7337
Practice Address - Fax:920-563-7705
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61077-20208000000X
MO2012020346208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO431560263OtherTRICARE
MOP01085141OtherMCR RR
AR193620001Medicaid
MO1275897019Medicaid
AR193620001Medicaid