Healthcare Provider Details

I. General information

NPI: 1215366091
Provider Name (Legal Business Name): ANGELA MULLEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44555 WOODWARD AVE
PONTIAC MI
48341-5031
US

IV. Provider business mailing address

1465 LILA DR
TROY MI
48085-3408
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-6104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: