Basic Information
Provider Information | |||||||||
NPI: | 1083660344 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MUSSEMANN | ||||||||
FirstName: | FRANK | ||||||||
MiddleName: | F | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1407 MCPHERSON AVE | ||||||||
Address2: |   | ||||||||
City: | MOUNT VERNON | ||||||||
State: | IL | ||||||||
PostalCode: | 628642822 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6182330017 | ||||||||
FaxNumber: | 6182330251 | ||||||||
Practice Location | |||||||||
Address1: | 180 S 3RD ST | ||||||||
Address2: | SUITE 200 | ||||||||
City: | BELLEVILLE | ||||||||
State: | IL | ||||||||
PostalCode: | 622201952 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6182330017 | ||||||||
FaxNumber: | 6182330251 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/26/2006 | ||||||||
LastUpdateDate: | 03/29/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 036091400 | IL | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 272435 | 01 | IL | HEALTHLINK | OTHER | 12014V3948 | 01 | IL | GROUP HEALTH PLAN | OTHER | 8215125 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER | 036091400 | 05 | IL |   | MEDICAID | 0707328 | 01 | IL | UHC MEDICARE COMPLETE | OTHER | 105469 | 01 | MO | ALLIANCE BC/BS | OTHER | 160025736 | 01 | IL | RAILROAD MEDICARE | OTHER |