MEDICARE: DR. KELLY ADRIENNE MUELLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	292375	MA
2	207R00000X	Internal Medicine Physician	125.072279	IL
3	390200000X	Student in an Organized Health Care Education/Training Program		NY
4	207N00000X	Dermatology Physician	036176629	IL

General Provider Information

NPI Number	:	1487148458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY ADRIENNE MUELLER MD

Provider Business Mailing Address
First Line	:	180 HARVESTER DR STE 110
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-6686
Country	:	US
Telephone Number	:	773-702-1150
Fax Number	:

Provider Business Practice Location Address
First Line	:	3122 N. ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3014
Country	:	US
Telephone Number	:	847-663-8060
Fax Number	:	847-663-1027

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2018
Last Update Date	:	08/18/2025

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