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General NPI Number Information
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NPI Number | 1700869195
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Entity Type | Individual
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Provider Name | NAWAL ELLEN RAGHEB-MUELLER D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 1225 WEST LAKE ST
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City | MELROSE PARK
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State | IL
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Zip | 60160
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Country | US
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Telephone | 708-681-3000
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Fax | 708-783-0920
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Provider Business Mailing Address
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Address Line | 3998 FAIR RIDGE DR SUITE 300
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City | FAIRFAX
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State | VA
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Zip | 22033-2907
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Country | US
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Telephone | 703-295-9360
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Fax | 703-766-9725
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036-113092
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License Number State | IL
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