Basic Information
| Provider Information | |||||||||
| NPI: | 1487643581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUEKSCH | ||||||||
| FirstName: | JOSEF | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | MD MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 344 ROLLING HILL RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281176865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044644439 | ||||||||
| FaxNumber: | 7046648802 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 HOSPITAL DR NE | ||||||||
| Address2: | |||||||||
| City: | BOLIVIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284228346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107211477 | ||||||||
| FaxNumber: | 9107211479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 01/24/2018 | ||||||||
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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 | 207L00000X | MD425214 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 200700171 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 25MA08508000 | NJ | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 5914754 | 05 | NC | MEDICAID |