Healthcare Provider Details

I. General information

NPI: 1750578019
Provider Name (Legal Business Name): MICHAEL BERNARD MUELLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL BERNARD MUELLER D.O.

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 W MARC KNIGHTON CT
LECANTO FL
34461-6300
US

IV. Provider business mailing address

2804 W MARC KNIGHTON CT
LECANTO FL
34461-6300
US

V. Phone/Fax

Practice location:
  • Phone: 352-746-8000
  • Fax: 352-746-8002
Mailing address:
  • Phone: 352-746-8000
  • Fax: 352-746-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS0007801
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: