Provider Demographics
NPI:1548223852
Name:MUELLER, KURT (CRNA)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:MUELLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9390 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1355
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7007 POWERS BLVD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5437
Practice Address - Country:US
Practice Address - Phone:440-743-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN184484367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000221230OtherUNISON
OH000000516001OtherANTHEM
OH7019398OtherAETNA
OH2387242Medicaid
OHP00402013OtherMEDICARE RAILROAD
OH749651OtherBUCKEYE MEDICAID
OH0583328OtherBCMH
OH377456OtherANTHEM BCBS
OH415012OtherWELLCARE MEDICAID
OH415012OtherWELLCARE MEDICAID
OH7019398OtherAETNA