Healthcare Provider Details

I. General information

NPI: 1245963008
Provider Name (Legal Business Name): AUSTIN MUELLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14017 JAMESTOWN RD
BREESE IL
62230-3647
US

IV. Provider business mailing address

14017 JAMESTOWN RD
BREESE IL
62230-3647
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-7154
  • Fax: 618-526-8248
Mailing address:
  • Phone: 618-526-7154
  • Fax: 618-526-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number135.001171
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016006106
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: