Provider Demographics
NPI:1700869195
Name:RAGHEB-MUELLER, NAWAL ELLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:NAWAL
Middle Name:ELLEN
Last Name:RAGHEB-MUELLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3998 FAIR RIDGE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2907
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:1225 WEST LAKE ST
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160
Practice Address - Country:US
Practice Address - Phone:708-681-3000
Practice Address - Fax:708-783-0920
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-113092207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-113092-1Medicaid
ILIL7200009Medicare PIN
ILI45051Medicare UPIN
IL036-113092-1Medicaid