Provider Demographics
NPI:1649260712
Name:MUSICH, THOMAS F (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:MUSICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12700 SOUTHFORK ROAD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3286
Mailing Address - Country:US
Mailing Address - Phone:314-842-0112
Mailing Address - Fax:314-842-5505
Practice Address - Street 1:12700 SOUTHFORK ROAD
Practice Address - Street 2:SUITE 250
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3286
Practice Address - Country:US
Practice Address - Phone:314-842-0112
Practice Address - Fax:314-842-5505
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2009-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR7857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4944OtherBLUE CHOICE BCBS MO
MO184175OtherBCBS OF MISSOURI
MO000001085Medicare PIN
MO184175OtherBCBS OF MISSOURI