MEDICARE: MARY ANN MULLICAN 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	2085R0202X	Diagnostic Radiology Physician	D4534	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619934015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN MULLICAN MD

Provider Business Mailing Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	DALLAS
State	:	TX
Zip	:	75390-8896
Country	:	US
Telephone Number	:	214-648-8018
Fax Number	:	214-648-2678

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:	DEPARTMENT OF RADIOLOGY
City	:	DALLAS
State	:	TX
Zip	:	75390-8896
Country	:	US
Telephone Number	:	214-648-8018
Fax Number	:	214-648-2678

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	03/25/2011

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