Healthcare Provider Details

I. General information

NPI: 1669113338
Provider Name (Legal Business Name): SEAN CORTES MULLIGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 05/06/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

4001 N 3RD ST STE 290
PHOENIX AZ
85012-2071
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number76041
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: