Provider Demographics
NPI:1811906548
Name:MUELLER, MATTHEW CARL (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CARL
Last Name:MUELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3901
Mailing Address - Country:US
Mailing Address - Phone:330-270-3660
Mailing Address - Fax:
Practice Address - Street 1:102 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3963
Practice Address - Country:US
Practice Address - Phone:330-270-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007088207PE0005X
OH34007088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2370929Medicaid
H75572Medicare UPIN
OH2370929Medicaid