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General NPI Number Information
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NPI Number | 1295737278
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Entity Type | Individual
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Provider Name | LAWRENCE G MULHERN MD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 606 24TH AVE S 700
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1455
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Country | US
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Telephone | 612-672-2450
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Fax |
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Provider Business Mailing Address
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Address Line | 606 24TH AVE S 700
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1455
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Country | US
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Telephone | 612-672-2450
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 33599
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License Number State | MN
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