Basic Information
| Provider Information | |||||||||
| NPI: | 1477592194 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUELLER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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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: | 06/06/2006 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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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 | 207VG0400X | 036048229 | IL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 244403684 | 01 | IL | GROUP HEALTH PLAN | OTHER | 0707048 | 01 | IL | UHC MEDICARE COMPLETE | OTHER | 036048229 | 05 | IL | MEDICAID | 821512 | 01 | IL | BC/BS | OTHER | 105592 | 01 | IL | ALLIANCE BC/BS | OTHER |