Healthcare Provider Details

I. General information

NPI: 1639407687
Provider Name (Legal Business Name): JAN ERIC MUHLBAUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MONROE AVE SUITE B
PITTSFORD NY
14534-1311
US

IV. Provider business mailing address

61 MONROE AVE SUITE B
PITTSFORD NY
14534-1311
US

V. Phone/Fax

Practice location:
  • Phone: 585-586-5166
  • Fax: 585-586-1370
Mailing address:
  • Phone: 585-586-5166
  • Fax: 585-586-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number150051-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: