Basic Information
| Provider Information | |||||||||
| NPI: | 1376509836 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUELLER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2139 AUBURN AVENUE | ||||||||
| Address2: | ROOM 6166 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135853488 | ||||||||
| FaxNumber: | 5135850011 | ||||||||
| Practice Location | |||||||||
| Address1: | 2139 AUBURN AVENUE | ||||||||
| Address2: | ROOM 6166 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135853488 | ||||||||
| FaxNumber: | 5135850011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 02/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 35045119M | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RG0300X | 35.045119 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0515491 | 05 | OH | MEDICAID | 64962798 | 05 | KY | MEDICAID | 200160800 | 05 | IN | MEDICAID |