Provider Demographics
NPI:1831176775
Name:MUSICK, STEVE EARL I (MD)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:EARL
Last Name:MUSICK
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4948 BENCHMARK CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2027
Mailing Address - Country:US
Mailing Address - Phone:618-628-2588
Mailing Address - Fax:618-628-1363
Practice Address - Street 1:4948 BENCHMARK CENTRE DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2027
Practice Address - Country:US
Practice Address - Phone:618-628-2588
Practice Address - Fax:618-628-1363
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089938207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089938Medicaid
IL31779OtherBCBS OF MO
IL070007234OtherMEDICARE RR PTAN
IL036089938Medicaid