Provider Demographics
NPI:1750466835
Name:MUELLER, JOAN LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:LOUISE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:430 E DIVISION ST
Mailing Address - Street 2:ST. AGNES HOSPITAL PATHOLOGY DEPT
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4560
Mailing Address - Country:US
Mailing Address - Phone:920-926-5800
Mailing Address - Fax:920-926-4300
Practice Address - Street 1:430 E DIVISION ST
Practice Address - Street 2:ST. AGNES HOSPITAL PATHOLOGY DEPT
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4560
Practice Address - Country:US
Practice Address - Phone:920-926-5800
Practice Address - Fax:920-926-4300
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI23828207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30711000Medicaid
WI30711000Medicaid
WI000222050Medicare PIN