Provider Demographics
NPI:1285638072
Name:HUSS, M STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:M STEPHEN
Middle Name:
Last Name:HUSS
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 1:304 W HAY ST
Mailing Address - Street 2:STE 213
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4169
Mailing Address - Country:US
Mailing Address - Phone:217-875-1518
Mailing Address - Fax:217-875-9309
Practice Address - Street 1:304 W HAY ST
Practice Address - Street 2:STE 213
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4169
Practice Address - Country:US
Practice Address - Phone:217-875-1518
Practice Address - Fax:217-875-9309
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE14057Medicare UPIN
IL644110Medicare ID - Type Unspecified