=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275976540
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYLE MUELLER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2013
-----------------------------------------------------
Last Update Date | 02/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 SPRUCE ST. 3RD FLOOR - SUITE 302
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-5701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-829-6700
-----------------------------------------------------
Fax | 215-829-6645
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1865 ROUTE 70 EAST
-----------------------------------------------------
City | CHERRY HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08003-8003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-829-6700
-----------------------------------------------------
Fax | 215-829-6645
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | MD17042
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | MD474698
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------