MEDICARE: LAWRENCE G MULHERN MD

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
1	207Q00000X	Family Medicine Physician	33599	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	080125049	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	FP1420457006	OTHER	PREFERRED ONE
2	FP2354	OTHER	AMERICAS PPO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	107866	OTHER	UCARE MEDICAL ASSIST
6	0127633	OTHER	MEDICA
7	107866C620	OTHER	UCARE FOR SENIOR
8	5F081MU	OTHER	BLUE CROSS

General Provider Information

NPI Number	:	1295737278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE G MULHERN MD

Provider Business Mailing Address
First Line	:	606 24TH AVE S
Second Line	:	700
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1455
Country	:	US
Telephone Number	:	612-672-2450
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 24TH AVE S
Second Line	:	700
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1455
Country	:	US
Telephone Number	:	612-672-2450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	04/05/2012

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