MEDICARE: MICHAEL MUSCATELLA LTD

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	213ES0103X	Foot & Ankle Surgery Podiatrist	016004109	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC3185	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1134318827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL MUSCATELLA LTD

Provider Business Mailing Address
First Line	:	3125 VILLAGE OFFICE PL
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-7673
Country	:	US
Telephone Number	:	217-398-3338
Fax Number	:	217-398-4961

Provider Business Practice Location Address
First Line	:	3125 VILLAGE OFFICE PL
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-7673
Country	:	US
Telephone Number	:	217-398-3338
Fax Number	:	217-398-4961

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL MUSCATELLA
Credential	:	DPM
Telephone Number	:	217-398-3338

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	03/22/2010

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