Individual
DR. MICHELE L. MUSTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
820 PRUDENTIAL DR STE 304, JACKSONVILLE, FL 32207-8205
(904) 202-3860
(904) 202-3846
Mailing address
PO BOX 45443, SALT LAKE CITY, UT 84145-0443
(904) 202-1032
(904) 376-4107
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
000556
GA
207QA0505X
Adult Medicine Physician
112784
FL
207QA0505X
Adult Medicine Physician
180956
NC
207QA0505X
Adult Medicine Physician
TL31424
SC
208M00000X
Hospitalist Physician
Primary
ME112784
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01067717
AMERIGROUP MEDICAID
GA
05
—
013879800
—
FL
01
—
395491
WELLCARE MEDICAID
GA
05
—
770574093A
—
GA
Enumeration date
06/01/2007
Last updated
01/25/2019
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