MEDICARE: MR. MICHAEL DAVID MULCAHEY ATC LAT

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
1	2255A2300X	Athletic Trainer	AT-001468	OH

General Provider Information

NPI Number	:	1447216346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL DAVID MULCAHEY ATC LAT

Provider Business Mailing Address
First Line	:	8572 SHUMAN LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-5737
Country	:	US
Telephone Number	:	513-745-2928
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 VICTORY PKWY
Second Line	:	SPORTS MEDICINE
City	:	CINCINNATI
State	:	OH
Zip	:	45207-1035
Country	:	US
Telephone Number	:	513-745-2928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	07/08/2007

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