Provider Demographics
NPI:1710045265
Name:HUSET, RICHARD ALFRED (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALFRED
Last Name:HUSET
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 1:2158 COUNTY RD B
Mailing Address - Street 2:
Mailing Address - City:LUCK
Mailing Address - State:WI
Mailing Address - Zip Code:54853
Mailing Address - Country:US
Mailing Address - Phone:715-648-5620
Mailing Address - Fax:
Practice Address - Street 1:2158 295TH AVE
Practice Address - Street 2:
Practice Address - City:LUCK
Practice Address - State:WI
Practice Address - Zip Code:54853-3419
Practice Address - Country:US
Practice Address - Phone:715-648-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31727200Medicaid
WI31727200Medicaid