Provider Demographics
NPI:1063630093
Name:MUHLERT, MICHAEL KEENE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KEENE
Last Name:MUHLERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 PARK AVE
Mailing Address - Street 2:MEMPHIS PHYSICIANS RADIOLOGY PRACTICE GROUP
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5198
Mailing Address - Country:US
Mailing Address - Phone:901-765-3213
Mailing Address - Fax:901-765-1727
Practice Address - Street 1:5959 PARK AVE
Practice Address - Street 2:MPRG
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5200
Practice Address - Country:US
Practice Address - Phone:901-765-3213
Practice Address - Fax:901-765-1727
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS198652085R0202X, 2085R0204X
TN0427102085R0202X
ARE-53362085R0204X, 2085R0202X
TN427102085R0204X
SC320392085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
12112969OtherCAQH