MEDICARE: DR. KENNETH H MUSSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	4301025943	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598759821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH H MUSSON M.D.

Provider Business Mailing Address
First Line	:	929 BUSINESS PARK DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-8683
Country	:	US
Telephone Number	:	231-947-6246
Fax Number	:	231-947-8864

Provider Business Practice Location Address
First Line	:	929 BUSINESS PARK DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-8683
Country	:	US
Telephone Number	:	231-947-6246
Fax Number	:	231-947-8864

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/15/2009

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