Provider Demographics
NPI:1821201948
Name:PETER J MUELLEMAN
Entity Type:Organization
Organization Name:PETER J MUELLEMAN
Other - Org Name:AFFILIATED DERMATOLOGY AND SKIN CANCER CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUELLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-478-1830
Mailing Address - Street 1:19101 E VALLEY VIEW PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6907
Mailing Address - Country:US
Mailing Address - Phone:816-478-1830
Mailing Address - Fax:816-478-8429
Practice Address - Street 1:19101 E VALLEY VIEW PKWY STE A
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6907
Practice Address - Country:US
Practice Address - Phone:816-478-1830
Practice Address - Fax:816-478-8429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD R6F98207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC50512Medicare UPIN
MOX750000Medicare PIN