Healthcare Provider Details

I. General information

NPI: 1093739427
Provider Name (Legal Business Name): JOHN FLORIAN HUSSA MD AODAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/07/2023
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 MAPLE LN
ASHLAND WI
54806-3626
US

IV. Provider business mailing address

1615 MAPLE LN
ASHLAND WI
54806-3626
US

V. Phone/Fax

Practice location:
  • Phone: 715-685-5500
  • Fax: 715-685-5102
Mailing address:
  • Phone: 715-685-5500
  • Fax: 715-685-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number17169
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number17169
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: