Provider Demographics
NPI:1114417672
Name:MUELLER, KYLE THOMAS
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:THOMAS
Last Name:MUELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30014 ALDINE WESTFIELD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2994
Mailing Address - Country:US
Mailing Address - Phone:936-270-4822
Mailing Address - Fax:936-270-4821
Practice Address - Street 1:30014 ALDINE WESTFIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2994
Practice Address - Country:US
Practice Address - Phone:936-270-4822
Practice Address - Fax:936-270-4821
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU7247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU7247OtherTX LICENSE