Healthcare Provider Details

I. General information

NPI: 1568811644
Provider Name (Legal Business Name): MULLEN ORTHOPEDIC CLINIC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4852 E BASELINE RD STE 107
MESA AZ
85206-4628
US

IV. Provider business mailing address

4852 E BASELINE RD STE 107
MESA AZ
85206-4628
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-7000
  • Fax: 480-834-7002
Mailing address:
  • Phone: 480-834-7000
  • Fax: 480-834-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL J MULLEN
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 480-834-7000