Provider Demographics
NPI:1811769086
Name:MUELLER SPORTS MEDICINE
Entity type:Organization
Organization Name:MUELLER SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:954-804-2825
Mailing Address - Street 1:1 QUENCH DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-2100
Mailing Address - Country:US
Mailing Address - Phone:954-804-2825
Mailing Address - Fax:
Practice Address - Street 1:1 QUENCH DR
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-2100
Practice Address - Country:US
Practice Address - Phone:954-804-2825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies