Basic Information
| Provider Information | |||||||||
| NPI: | 1124014329 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FERDINAND J. MUELLER, LTD. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 180 S 3RD ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622201952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182330017 | ||||||||
| FaxNumber: | 6182330251 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 S 3RD ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622201952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182330017 | ||||||||
| FaxNumber: | 6182330251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 02/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | MUELLER | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | V. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6182330017 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 130304 | 01 | MO | BLUE ADVANTAGE | OTHER | 2444V9469 | 01 | MO | GROUP HEALTH PLAN | OTHER | 231290 | 01 | IL | MEDICARE GROUP | OTHER | 105592 | 01 | MO | BLUE ADVANTAGE | OTHER | 111843 | 01 | MO | BLUE ADVANTAGE | OTHER | 8215125 | 01 | IL | BC/BS | OTHER | 105469 | 01 | MO | BLUE ADVANTAGE | OTHER | 2113V9469 | 01 | MO | GROUP HEALTH PLAN | OTHER |