Provider Demographics
NPI:1568409910
Name:ALLAN O. MUEHRCKE, MD,SC
Entity Type:Organization
Organization Name:ALLAN O. MUEHRCKE, MD,SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:MUEHRCKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-848-4630
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-005714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL687421OtherPTAN
IL687421OtherPTAN
IL687421Medicare PIN