Provider Demographics
NPI:1649342759
Name:STEPHEN MUSSER DPM, INC.
Entity type:Organization
Organization Name:STEPHEN MUSSER DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-777-5358
Mailing Address - Street 1:25043 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2054
Mailing Address - Country:US
Mailing Address - Phone:440-777-5358
Mailing Address - Fax:440-777-5922
Practice Address - Street 1:25043 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2054
Practice Address - Country:US
Practice Address - Phone:440-777-5358
Practice Address - Fax:440-777-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002574213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3645278A11OtherANTHEM EAST
OH0652482OtherMEDICARE GROUP
OHP00000271OtherRAILROAD
OH0752681Medicaid
OH0752681Medicaid
OH0652482OtherMEDICARE GROUP
OH3645278A11OtherANTHEM EAST