Provider Demographics
NPI:1538153804
Name:MUELLER, MARY (PA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MUELLER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:350 SURRYSE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2313
Mailing Address - Country:US
Mailing Address - Phone:847-438-2144
Mailing Address - Fax:847-438-1597
Practice Address - Street 1:15 S OLD RAND RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2313
Practice Address - Country:US
Practice Address - Phone:847-438-2144
Practice Address - Fax:847-438-1597
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2021-12-21
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Provider Licenses
StateLicense IDTaxonomies
IL085000455363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical