Healthcare Provider Details

I. General information

NPI: 1689874745
Provider Name (Legal Business Name): DAVID W MUELLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 5TH ST
RAPID CITY SD
57701-7316
US

IV. Provider business mailing address

2905 5TH ST
RAPID CITY SD
57701-7316
US

V. Phone/Fax

Practice location:
  • Phone: 605-341-7337
  • Fax: 605-341-2447
Mailing address:
  • Phone: 605-341-7337
  • Fax: 605-341-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number7058
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3702010
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer
# 2
Identifier7058
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerSTATE MEDICAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: