Provider Demographics
NPI:1265473557
Name:MUELLER, KURT (DO)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:MUELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 SE 37TH LN
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-4770
Mailing Address - Country:US
Mailing Address - Phone:239-424-3513
Mailing Address - Fax:
Practice Address - Street 1:636 DEL PRADO BLVD S
Practice Address - Street 2:1030
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2668
Practice Address - Country:US
Practice Address - Phone:239-424-3513
Practice Address - Fax:239-424-4039
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007419207P00000X
FLOS12683207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013796800Medicaid
OH942460636274OtherCARESOURCE
OH2233756Medicaid
OHP00194274OtherMEDICARE RR-GA
OH942460636274OtherCARESOURCE
FLHZ673ZMedicare PIN