Provider Demographics
NPI:1508185927
Name:MATTHEW C. MUELLER DO INC
Entity Type:Organization
Organization Name:MATTHEW C. MUELLER DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-652-1060
Mailing Address - Street 1:1160 NILES CORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3596
Mailing Address - Country:US
Mailing Address - Phone:330-652-1060
Mailing Address - Fax:330-652-1052
Practice Address - Street 1:1160 NILES CORTLAND RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-3596
Practice Address - Country:US
Practice Address - Phone:330-652-1060
Practice Address - Fax:330-652-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty