Provider Demographics
NPI:1578677498
Name:MUSSIN, ELIZABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MUSSIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4401 N CAMPUS RIDGE DR
Mailing Address - Street 2:SUITE D2100
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6112
Mailing Address - Country:US
Mailing Address - Phone:989-837-9300
Mailing Address - Fax:989-837-9307
Practice Address - Street 1:4401 N CAMPUS RIDGE DR
Practice Address - Street 2:SUITE D2100
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6112
Practice Address - Country:US
Practice Address - Phone:989-837-9300
Practice Address - Fax:989-837-9307
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-12-24
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Provider Licenses
StateLicense IDTaxonomies
MIEM068542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH98525Medicare UPIN
MIM43020024Medicare PIN