Basic Information
| Provider Information | |||||||||
| NPI: | 1740247436 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUELLER | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636256 | ||||||||
| Address2: | CENTRAL CREDENTIALING | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132453104 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3130 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135847425 | ||||||||
| FaxNumber: | 5135584399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 08/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2020-00294 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 35-062388 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 35-062388 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64935182 | 05 | KY | MEDICAID | 110227394 | 01 | OH | RAIL ROAD MEDICARE | OTHER | 4047834 | 05 | TN | MEDICAID | 0933968 | 05 | OH | MEDICAID | 200000960 | 05 | IN | MEDICAID |