Healthcare Provider Details

I. General information

NPI: 1942200076
Provider Name (Legal Business Name): MICHAEL B. SCHUSSLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 MEMORIAL DR
CLARKSVILLE TN
37043-4562
US

IV. Provider business mailing address

1762 MEMORIAL DR
CLARKSVILLE TN
37043-4562
US

V. Phone/Fax

Practice location:
  • Phone: 931-645-1199
  • Fax: 931-647-4358
Mailing address:
  • Phone: 931-645-1199
  • Fax: 931-647-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPH0305
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: