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General NPI Number Information
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NPI Number | 1538200050
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Entity Type | Individual
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Provider Name | MOLLY F LAIRD MCMULLEN MD
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 1825 W STADIUM BLVD
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City | ANN ARBOR
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State | MI
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Zip | 48103-4501
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Country | US
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Telephone | 734-222-1491
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Fax |
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Provider Business Mailing Address
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Address Line | 820 GRANGER AVE
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City | ANN ARBOR
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State | MI
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Zip | 48104-3828
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301069605
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License Number State | MI
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