Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 125.056383 | IL |
Y | 2080P0202X | Pediatric Cardiologist | 036130882 | IL |
NPI | 1053553313 |
---|---|
Provider Name | Brie-Ann Alexandra Muller |
First Address | Chicago, IL 60678-0353 |
Second Address | Olympia Fields, IL 60461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2009 |
Last Update Date | 20/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F400330012 | MEDICARE PTAN (01) | IL |