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General NPI Number Information
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NPI Number | 1649218694
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Entity Type | Organization
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Legal Business Name | KINGS BAY FAMILY CARE PA
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 08/10/2012
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Provider Practice Location Address
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Address Line | 9030 W FORT ISLAND TRL SUITE 1
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-2412
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Country | US
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Telephone | 352-795-2273
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Fax | 352-795-2296
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Provider Business Mailing Address
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Address Line | 14690 SPRING HILL DR SUITE 101
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City | SPRING HILL
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State | FL
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Zip | 34609-8102
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Country | US
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Telephone | 352-795-2273
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Fax | 352-795-2296
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL B MUELLER
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Credential | D.O.
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Telephone | 352-795-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS7801
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License Number State | FL
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