Healthcare Provider Details

I. General information

NPI: 1073178786
Provider Name (Legal Business Name): NICHOLAS MUELLER PIENING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12266 DE PAUL DR STE 305
BRIDGETON MO
63044-2514
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-5534
US

V. Phone/Fax

Practice location:
  • Phone: 314-770-0991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2025039102
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: