Provider Demographics
NPI:1558589374
Name:MUELLER, TRICIA LEA (DO)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:LEA
Last Name:MUELLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:LEA
Other - Last Name:ANSCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:STE 221
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:2080 44TH ST SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508
Practice Address - Country:US
Practice Address - Phone:616-685-8100
Practice Address - Fax:616-455-5052
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N27520OtherMEDICARE GROUP NUMBER
MIP32930319Medicare PIN
MI0M02830192Medicare PIN