Provider Demographics
NPI:1629049051
Name:MUSSER, STEPHEN CHARLES (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHARLES
Last Name:MUSSER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25043 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2054
Mailing Address - Country:US
Mailing Address - Phone:440-777-5358
Mailing Address - Fax:440-777-5922
Practice Address - Street 1:25043 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2054
Practice Address - Country:US
Practice Address - Phone:440-777-5358
Practice Address - Fax:440-777-5922
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002574M213E00000X
OH36-002574213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4881560002OtherDME
OHP00000271OtherRAILROAD
OK000000287348OtherANTHEM
OH0752681Medicaid
OH0752681Medicaid