Basic Information
Provider Information
NPI: 1528091253
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MUELHEIMS
FirstName: GERHARD
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential: MD, FACC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 331
Address2:  
City: LIBERTY LAKE
State: WA
PostalCode: 990190331
CountryCode: US
TelephoneNumber: 8667472455
FaxNumber:  
Practice Location
Address1: 122 W 7TH AVE
Address2: 450
City: SPOKANE
State: WA
PostalCode: 992042349
CountryCode: US
TelephoneNumber: 5094558820
FaxNumber: 5098384978
Other Information
ProviderEnumerationDate: 07/08/2006
LastUpdateDate: 06/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XMD00040855WAN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RC0000XM8565IDN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RC0001XMD00040855WAY Allopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology

ID Information
IDTypeStateIssuerDescription
06006820601WARRBOTHER
80407380005ID MEDICAID
829682405WA MEDICAID


Home