Basic Information
| Provider Information | |||||||||
| NPI: | 1891756128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULLER | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 4TH ST | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122340220 | ||||||||
| FaxNumber: | 7122340225 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 4TH ST | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122340220 | ||||||||
| FaxNumber: | 7122340225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 12/21/2007 | ||||||||
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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 | 2084P0800X | 03099 | IA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 4157164 | 05 | IA | MEDICAID |