Provider Demographics
NPI:1942200076
Name:SCHUSSLER, MICHAEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:SCHUSSLER
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 1:1762 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4562
Mailing Address - Country:US
Mailing Address - Phone:931-645-1199
Mailing Address - Fax:931-647-4358
Practice Address - Street 1:1762 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4562
Practice Address - Country:US
Practice Address - Phone:931-645-1199
Practice Address - Fax:931-647-4358
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPH0305213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3353012Medicaid
TN0714590001Medicare NSC
TN3353012Medicaid
TN3353012Medicare PIN