Healthcare Provider Details

I. General information

NPI: 1275890584
Provider Name (Legal Business Name): SABINA CHOWDHURY MULLIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E LAYTON AVE
ST FRANCIS WI
53235-6053
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 414-774-6589
  • Fax:
Mailing address:
  • Phone: 414-744-6589
  • Fax: 414-259-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64742
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number64742
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: