Provider Demographics
NPI:1548213150
Name:MUEHRCKE, ALLAN OWEN (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:OWEN
Last Name:MUEHRCKE
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 1:1 ERIE CT
Mailing Address - Street 2:SUITE 4010
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2566
Mailing Address - Country:US
Mailing Address - Phone:708-848-4630
Mailing Address - Fax:708-848-4672
Practice Address - Street 1:1 ERIE CT
Practice Address - Street 2:SUITE 4010
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2566
Practice Address - Country:US
Practice Address - Phone:708-848-4630
Practice Address - Fax:708-848-4672
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36061226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061226Medicaid
ILC41754Medicare UPIN
IL036061226Medicaid