MEDICARE: DR. GEORGE PETER MULOPULOS M.D.

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	2085R0202X	Diagnostic Radiology Physician	5356	NV
2	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	5356	NV
3	2085N0700X	Neuroradiology Physician	5356	NV
4	2085B0100X	Body Imaging Physician	5356	NV

General Provider Information

NPI Number	:	1912934498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE PETER MULOPULOS M.D.

Provider Business Mailing Address
First Line	:	11995 SINGLETREE LN
Second Line	:	SUITE 500
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-5347
Country	:	US
Telephone Number	:	952-595-1301
Fax Number	:	612-294-4903

Provider Business Practice Location Address
First Line	:	67 PRINCEVILLE LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1369
Country	:	US
Telephone Number	:	952-595-1100
Fax Number	:	612-294-4903

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	06/23/2015

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