Provider Demographics
NPI:1790717676
Name:MUSICH, DAVID P (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:MUSICH
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 1:101 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-282-3899
Mailing Address - Fax:812-282-4172
Practice Address - Street 1:1322 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3706
Practice Address - Country:US
Practice Address - Phone:812-285-6000
Practice Address - Fax:812-285-6010
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060627A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200526060Medicaid
KY64130677Medicaid
IN01060627AOtherMEDICAL LICENSE
KY40371OtherMEDICAL LICENSE
FM0675390OtherDEA CERTIFICATE
KY40371OtherMEDICAL LICENSE
IN01060627AOtherMEDICAL LICENSE
KY64130677Medicaid
KY1165025Medicare PIN