Provider Demographics
NPI:1801610407
Name:MUSSER, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MUSSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 S 700 W
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IN
Mailing Address - Zip Code:46747-9003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3910 S 700 W
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:IN
Practice Address - Zip Code:46747-9003
Practice Address - Country:US
Practice Address - Phone:260-228-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver