Provider Demographics
NPI:1376614842
Name:MULLER, LIANE M (DO)
Entity Type:Individual
Prefix:
First Name:LIANE
Middle Name:M
Last Name:MULLER
Suffix:
Gender:F
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:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009
Mailing Address - Country:US
Mailing Address - Phone:207-647-2440
Mailing Address - Fax:207-647-3775
Practice Address - Street 1:63 MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009
Practice Address - Country:US
Practice Address - Phone:207-647-2440
Practice Address - Fax:207-647-3775
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1869204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1127587OtherAETNA
ME431995900Medicaid
ME099629OtherBCBS
ME5488624OtherCIGNA
ME079115OtherANTHEM
ME133516OtherHARV PILGRIM
I33516Medicare UPIN
MEME1384Medicare UPIN