Provider Demographics
NPI:1790136463
Name:MUELLER, BENJAMIN
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:MUELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:MI
Mailing Address - Zip Code:48883-9020
Mailing Address - Country:US
Mailing Address - Phone:989-621-1758
Mailing Address - Fax:
Practice Address - Street 1:106 W COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:SHEPHERD
Practice Address - State:MI
Practice Address - Zip Code:48883-9020
Practice Address - Country:US
Practice Address - Phone:989-621-1758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other