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General NPI Number Information
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NPI Number | 1225442247
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Entity Type | Individual
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Provider Name | KEVIN MCMULLEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2014
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 1821 SOUTH AVE W STE 402
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City | MISSOULA
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State | MT
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Zip | 59801-6518
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Country | US
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Telephone | 406-543-8512
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Fax | 406-541-8513
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Provider Business Mailing Address
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Address Line | 801 YORK S T
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City | MANITOWOC
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State | WI
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Zip | 54220-4630
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Country | US
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Telephone | 206-639-0089
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Fax | 920-684-1439
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A142278
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 260111
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License Number State | MA
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