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NPI Code Detail

MEDICARE: ROBERT H. MUSSELMAN M.D.

MEDICARE: ROBERT H. MUSSELMAN M.D.
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
1207Q00000XFamily Medicine Physician01025416AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5080121951OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000000831OTHERMPLAN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000091874OTHERBLUE CROSS BLUE SHIELD
41619OTHERPHYSICIANS HEALTH PLAN

General Provider Information

NPI Number : 1619958766
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT H. MUSSELMAN M.D.
Provider Business Mailing Address
First Line : 3534 BROOKLYN AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46809-1361
Country : US
Telephone Number : 260-747-6171
Fax Number : 260-478-5125
Provider Business Practice Location Address
First Line : 3534 BROOKLYN AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46809-1361
Country : US
Telephone Number : 260-478-5180
Fax Number : 260-478-5185
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 08/22/2013

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