Provider Demographics
NPI:1053339408
Name:MULLER, ROBERT ALEXANDER (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:MULLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 SIM HODGIN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1931
Mailing Address - Country:US
Mailing Address - Phone:765-747-6090
Mailing Address - Fax:
Practice Address - Street 1:3500 W PURDUE AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-6357
Practice Address - Country:US
Practice Address - Phone:765-747-6090
Practice Address - Fax:765-747-5069
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000769A363AM0700X
IN99016197A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ47098Medicare UPIN
218420CMedicare ID - Type Unspecified