Provider Demographics
NPI:1588781892
Name:CRAIG R MUELLER MD INC
Entity type:Organization
Organization Name:CRAIG R MUELLER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-962-1110
Mailing Address - Street 1:8820 SVL BOX
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5180
Mailing Address - Country:US
Mailing Address - Phone:760-962-1110
Mailing Address - Fax:760-946-1069
Practice Address - Street 1:18535 NIAGARA DRIVE
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5180
Practice Address - Country:US
Practice Address - Phone:760-962-1110
Practice Address - Fax:760-946-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G487181Medicaid
CAE02681Medicare UPIN
CA00G487180Medicare ID - Type Unspecified