Provider Demographics
NPI:1659637270
Name:MAUREN MUECKE MD PC
Entity Type:Organization
Organization Name:MAUREN MUECKE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUECKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-824-3223
Mailing Address - Street 1:2010 PATTON CHAPEL RD
Mailing Address - Street 2:STE 206
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5784
Mailing Address - Country:US
Mailing Address - Phone:205-824-3223
Mailing Address - Fax:205-979-1449
Practice Address - Street 1:2010 PATTON CHAPEL RD
Practice Address - Street 2:STE 206
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-5784
Practice Address - Country:US
Practice Address - Phone:205-824-3223
Practice Address - Fax:205-979-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000076040Medicare PIN