Provider Demographics
NPI:1750578019
Name:MUELLER, MICHAEL BERNARD (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BERNARD
Last Name:MUELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:BERNARD
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2804 W MARC KNIGHTON CT
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-6300
Mailing Address - Country:US
Mailing Address - Phone:352-746-8000
Mailing Address - Fax:352-746-8002
Practice Address - Street 1:2804 W MARC KNIGHTON CT
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-6300
Practice Address - Country:US
Practice Address - Phone:352-746-8000
Practice Address - Fax:352-746-8002
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007801207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46431OtherBCBS
FL080180883OtherRR MCR
FL46431WMedicare PIN
FL080180883OtherRR MCR