MEDICARE: DR. LOUIS A MUSSO D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	49240	WI
2	2086S0129X	Vascular Surgery Physician	49240	WI
3	208600000X	Surgery Physician	5566	AZ
4	2086S0129X	Vascular Surgery Physician	5566	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073512976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS A MUSSO D.O.

Provider Business Mailing Address
First Line	:	1520 E HAMMER LN
Second Line	:	STE. 104
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6664
Country	:	US
Telephone Number	:	928-768-1200
Fax Number	:	928-768-1209

Provider Business Practice Location Address
First Line	:	1520 E HAMMER LN
Second Line	:	SUITE 104
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6664
Country	:	US
Telephone Number	:	928-768-1200
Fax Number	:	928-768-1209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/26/2016

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Directions to “ DR. LOUIS A MUSSO D.O.” Practice Location

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