Healthcare Provider Details

I. General information

NPI: 1619199619
Provider Name (Legal Business Name): TED B MUILENBURG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LA BRANCH ST
HOUSTON TX
77004-4046
US

IV. Provider business mailing address

3900 LA BRANCH ST
HOUSTON TX
77004-4046
US

V. Phone/Fax

Practice location:
  • Phone: 713-524-3949
  • Fax: 713-524-3915
Mailing address:
  • Phone: 713-524-3949
  • Fax: 713-524-3915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number407
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: