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General NPI Number Information
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NPI Number | 1649260712
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Entity Type | Individual
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Provider Name | THOMAS F MUSICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 12700 SOUTHFORK ROAD SUITE 250
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City | ST. LOUIS
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State | MO
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Zip | 63128-3286
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Country | US
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Telephone | 314-842-0112
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Fax | 314-842-5505
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Provider Business Mailing Address
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Address Line | 12700 SOUTHFORK ROAD SUITE 250
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City | ST. LOUIS
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State | MO
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Zip | 63128-3286
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Country | US
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Telephone | 314-842-0112
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Fax | 314-842-5505
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R7857
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License Number State | MO
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