Provider Demographics
NPI:1336256825
Name:MUSSELMAN, MARK S (MD)
Entity Type:Individual
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First Name:MARK
Middle Name:S
Last Name:MUSSELMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:1701 W. CURTIS ROAD
Practice Address - Street 2:PEDIATRICS
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822
Practice Address - Country:US
Practice Address - Phone:217-365-6202
Practice Address - Fax:217-326-1234
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-05-07
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Provider Licenses
StateLicense IDTaxonomies
IL0361047152080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3270297Medicare PIN
IL6447860004Medicare NSC
H44898Medicare UPIN
ILH44898Medicare UPIN