Provider Demographics
NPI:1871569186
Name:MUELLER, ELIZABETH ROSE
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ROSE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ROSE
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-5102
Mailing Address - Fax:708-216-1699
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-5102
Practice Address - Fax:708-216-1699
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36104051208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK17440OtherMEDICARE
IL36104051Medicaid
I29492Medicare UPIN
ILK17440OtherMEDICARE