Healthcare Provider Details

I. General information

NPI: 1376614842
Provider Name (Legal Business Name): LIANE M MULLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 MAIN STREET SUITE A
BRIDGTON ME
04009
US

IV. Provider business mailing address

PO BOX 118
BRIDGTON ME
04009
US

V. Phone/Fax

Practice location:
  • Phone: 207-647-2440
  • Fax: 207-647-3775
Mailing address:
  • Phone: 207-647-2440
  • Fax: 207-647-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1869
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: