Healthcare Provider Details

I. General information

NPI: 1255387692
Provider Name (Legal Business Name): HELEN MUSSEMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S 3RD ST SUITE 200
BELLEVILLE IL
62220-1952
US

IV. Provider business mailing address

180 S 3RD ST SUITE 200
BELLEVILLE IL
62220-1952
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-0017
  • Fax: 618-233-0251
Mailing address:
  • Phone: 618-233-0017
  • Fax: 618-233-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036102312
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: