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NPI Code Detail

MEDICARE: JOHN PAUL MULLIGAN MS

MEDICARE: JOHN PAUL MULLIGAN MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2101YM0800XMental Health Counselor4385OK

General Provider Information

NPI Number : 1063602274
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN PAUL MULLIGAN MS
Provider Business Mailing Address
First Line : 650 S PEORIA AVE
Second Line :
City : TULSA
State : OK
Zip : 74120-4429
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1055 S HOUSTON AVE
Second Line :
City : TULSA
State : OK
Zip : 74127-9043
Country : US
Telephone Number : 918-712-4301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2007
Last Update Date : 02/02/2016

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