Healthcare Provider Details

I. General information

NPI: 1063436699
Provider Name (Legal Business Name): TIMOTHY IAN MUELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C/O SAVAHCS 3601 S 6TH AVE
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

C/O SAVAHCS 3601 S 6TH AVE
TUCSON AZ
85723-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax: 520-629-4632
Mailing address:
  • Phone: 520-792-1450
  • Fax: 520-629-4632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD07397
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: