Individual
MICHAEL R. MUSTARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1005 BROADWAY ST, QUINCY, IL 62301-2834
(217) 223-8400
(217) 214-5837
Mailing address
1005 BROADWAY ST, QUINCY, IL 62301-2834
(217) 223-8400
(217) 277-3960
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036115033
IL
207Q00000X
Family Medicine Physician
2009-00236
NC
207Q00000X
Family Medicine Physician
2009038317
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036115033
—
IL
05
—
2009038317
—
MO
05
—
5911855
—
NC
Enumeration date
09/28/2006
Last updated
08/06/2025
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