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NPI Code Detail

MEDICARE: DELAND MAURICE MCMULLAN JR.

MEDICARE: DELAND MAURICE MCMULLAN JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerMI
22255A2300XAthletic Trainer1258592MI

General Provider Information

NPI Number : 1295345056
Entity Type Code : Individual
Provider Name (Legal Business Name) : DELAND MAURICE MCMULLAN JR.
Provider Business Mailing Address
First Line : PO BOX 970646
Second Line :
City : YPSILANTI
State : MI
Zip : 48197-0088
Country : US
Telephone Number : 734-320-4819
Fax Number :
Provider Business Practice Location Address
First Line : 1122 WALNUT ST
Second Line :
City : YPSILANTI
State : MI
Zip : 48198-3937
Country : US
Telephone Number : 734-320-4819
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2020
Last Update Date : 08/06/2020

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Directions to “ DELAND MAURICE MCMULLAN JR. ” Practice Location

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