Individual
MARY E KUSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1005 BROADWAY ST, QUINCY, IL 62301-2834
(217) 223-1200
Mailing address
1005 BROADWAY ST, QUINCY, IL 62301-2834
(217) 223-8400
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036126025
IL
207L00000X
Anesthesiology Physician
MDR9J41
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127254
BLUE SHIELD/BLUE CHOICE
MO
01
—
2002570
UNITED HEALTHCARE
MO
05
—
206958225
—
MO
01
—
237454
HEALTHLINK
MO
Enumeration date
05/04/2006
Last updated
07/31/2025
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