Basic Information
| Provider Information | |||||||||
| NPI: | 1790717676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUSICH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 HOSPITAL BLVD | ||||||||
| Address2: | |||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122823899 | ||||||||
| FaxNumber: | 8122824172 | ||||||||
| Practice Location | |||||||||
| Address1: | 1322 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471303706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122856000 | ||||||||
| FaxNumber: | 8122856010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 11/03/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 01060627A | IN | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 200526060 | 05 | IN | MEDICAID | 64130677 | 05 | KY | MEDICAID | 01060627A | 01 | IN | MEDICAL LICENSE | OTHER | BM7692165 | 01 | IN | DEA CERTIFICATE | OTHER | FM0675390 | 01 | DEA CERTIFICATE | OTHER | 40371 | 01 | KY | MEDICAL LICENSE | OTHER |