=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093739427
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN FLORIAN HUSSA MD AODAC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1615 MAPLE LN
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54806-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-685-5500
-----------------------------------------------------
Fax | 715-685-5102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1615 MAPLE LN
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54806-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-685-5500
-----------------------------------------------------
Fax | 715-685-5102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0802X
-----------------------------------------------------
Taxonomy Name | Addiction Psychiatry Physician
-----------------------------------------------------
License Number | 17169
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 17169
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------