MEDICARE: DR. GEORGE MUI D.D.S.

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	1223G0001X	General Practice Dentistry	IL-019016520	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	364411832	OTHER	IL	TAX IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1962624775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE MUI D.D.S.

Provider Business Mailing Address
First Line	:	221 W PROSPECT AVE
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-3136
Country	:	US
Telephone Number	:	847-253-5901
Fax Number	:	847-253-5914

Provider Business Practice Location Address
First Line	:	221 W PROSPECT AVE
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-3136
Country	:	US
Telephone Number	:	847-253-5901
Fax Number	:	847-253-5914

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	10/10/2008

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