Basic Information
| Provider Information | |||||||||
| NPI: | 1134249386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUELLER | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MENKE | ||||||||
| OtherFirstName: | RENEE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 110 WEST UNDERWOOD STREET | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074223790 | ||||||||
| FaxNumber: | 4074254358 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 W UNDERWOOD ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074223790 | ||||||||
| FaxNumber: | 4074254358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | ME99785 | FL | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.