Provider Demographics
NPI:1811043037
Name:MUSACK, RANDY ALLAN (DO, DVM)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:ALLAN
Last Name:MUSACK
Suffix:
Gender:M
Credentials:DO, DVM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-387-5511
Mailing Address - Fax:
Practice Address - Street 1:50 SHERRY AVE
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552-1467
Practice Address - Country:US
Practice Address - Phone:715-762-7311
Practice Address - Fax:715-762-7306
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3392602085R0202X
WI47578-0212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology