Provider Demographics
NPI:1255387692
Name:MUSSEMANN, HELEN (MD)
Entity type:Individual
Prefix:DR
First Name:HELEN
Middle Name:
Last Name:MUSSEMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 S 3RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1952
Mailing Address - Country:US
Mailing Address - Phone:618-233-0017
Mailing Address - Fax:618-233-0251
Practice Address - Street 1:180 S 3RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1952
Practice Address - Country:US
Practice Address - Phone:618-233-0017
Practice Address - Fax:618-233-0251
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102312207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL12014V3948OtherGROUP HEALTH PLAN
IL437419OtherHEALTHLINK
IL8215125OtherBLUE CROSS BLUE SHIELD
IL0701230OtherUHC MEDICARE COMPLETE
IL160050128OtherRAILROAD MEDICARE
IL036102312Medicaid
MO130304OtherALLIANCE BC/BS
IL0701230OtherUHC MEDICARE COMPLETE
ILH18159Medicare UPIN