Kenneth Jerome Mueller III, D.O

Primary specialty

Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X

License

5101024611 Issued in MI

Practice address

3240 W Carleton Rd Ste B
Hillsdale, MI 49242-9458

Phone

(517) 610-5469

Fax

(517) 586-0228

NPI assigned

Apr 15, 2015

Reactivated

Aug 25, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Interoperability endpoints

• Direct secure messaging: kenneth.mueller@749128527708164.direct.elationemr.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1780071811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3240 W CARLETON RD STE B",
            "city": "HILLSDALE",
            "state": "MI",
            "postal_code": "492429458",
            "telephone_number": "517-610-5469",
            "fax_number": "517-586-0228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3240 W CARLETON RD STE B",
            "city": "HILLSDALE",
            "state": "MI",
            "postal_code": "492429458",
            "telephone_number": "517-610-5469",
            "fax_number": "517-586-0228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUELLER",
        "first_name": "KENNETH",
        "middle_name": "JEROME",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-15",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "deactivation_date": "2020-08-12",
        "reactivation_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "MI",
            "license": "5101024611",
            "primary": false
        },
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "MI",
            "license": "5101024611",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mandy Naugle

• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Hillsdale, MI
• Providers in Hillsdale, MI by specialty
• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.