Provider Demographics
NPI:1821439712
Name:MUELHAUSEN, ERIC JOHN (IDMT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:MUELHAUSEN
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 EVERGREEN PKWY
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-7702
Mailing Address - Country:US
Mailing Address - Phone:630-745-1519
Mailing Address - Fax:
Practice Address - Street 1:6151 EVERGREEN PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-7702
Practice Address - Country:US
Practice Address - Phone:630-745-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians