Provider Demographics
NPI:1194935262
Name:MUSSAT, FLORENCE (MD)
Entity type:Individual
Prefix:DR
First Name:FLORENCE
Middle Name:
Last Name:MUSSAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 930
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-751-9000
Mailing Address - Fax:773-506-0535
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE 930
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-751-9000
Practice Address - Fax:773-506-0535
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-085474174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMU002856Medicare ID - Type Unspecified
ILG60683Medicare UPIN