Individual
FRED S MUSHKAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
407 E 3RD ST, ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER, DULUTH, MN 55805-1950
(218) 786-4000
Mailing address
407 E 3RD ST, ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER, DULUTH, MN 55805-1950
(218) 786-4000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
106902
MN
207P00000X
Emergency Medicine Physician
31075
KY
207P00000X
Emergency Medicine Physician
Primary
56653
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000328956
BLUE CROSS
KY
05
—
1538112511
—
MN
05
—
1538112511
—
WI
05
—
64310758
—
KY
01
—
P00097181
RAILROAD MEDICARE
KY
Enumeration date
05/18/2006
Last updated
03/07/2023
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