Provider Demographics
NPI:1619983384
Name:MUELLNER, PHYLLIS MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:MICHELLE
Last Name:MUELLNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:P. MICHELLE
Other - Middle Name:
Other - Last Name:MUELLNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:355 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3167
Mailing Address - Country:US
Mailing Address - Phone:312-238-1000
Mailing Address - Fax:
Practice Address - Street 1:1900 SILVER CROSS BLVD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9509
Practice Address - Country:US
Practice Address - Phone:815-300-7904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0990322081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL250011649OtherRAILROAD MEDICARE
IL250011937OtherRAILROAD MEDICARE
IL036099032Medicaid
ILL73545Medicare PIN
ILL76329Medicare PIN
IL250011649OtherRAILROAD MEDICARE
IL250011937OtherRAILROAD MEDICARE