Provider Demographics
NPI:1003831652
Name:MUELLER, SUSAN KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KATHLEEN
Last Name:MUELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2605 KENTUCKY AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3817
Mailing Address - Country:US
Mailing Address - Phone:270-444-9199
Mailing Address - Fax:270-444-9299
Practice Address - Street 1:2605 KENTUCKY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3817
Practice Address - Country:US
Practice Address - Phone:270-444-9199
Practice Address - Fax:270-444-9299
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37833207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64060288Medicaid
KYH77617Medicare UPIN
KY0758402Medicare ID - Type Unspecified