Provider Demographics
NPI: | 1376509836 |
---|---|
Name: | MUELLER, STEPHEN DAVID (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | STEPHEN |
Middle Name: | DAVID |
Last Name: | MUELLER |
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: | 2139 AUBURN AVENUE |
Mailing Address - Street 2: | ROOM 6166 |
Mailing Address - City: | CINCINNATI |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45219-2905 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 513-585-3488 |
Mailing Address - Fax: | 513-585-0011 |
Practice Address - Street 1: | 2139 AUBURN AVENUE |
Practice Address - Street 2: | ROOM 6166 |
Practice Address - City: | CINCINNATI |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45219-2906 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-585-3488 |
Practice Address - Fax: | 513-585-0011 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-04-25 |
Last Update Date: | 2013-02-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35045119M | 207RG0300X |
OH | 35.045119 | 207RG0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 0515491 | Medicaid | |
KY | 64962798 | Medicaid | |
IN | 200160800 | Medicaid | |
OH | 0515491 | Medicaid | |
OH | MU4247751 | Medicare PIN |