MEDICARE: REJEANA MULLINS M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	036104077	IL

General Provider Information

NPI Number	:	1689627853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REJEANA MULLINS M.D.

Provider Business Mailing Address
First Line	:	27 PEBBLEBROOK CT
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61705-6300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 PEBBLEBROOK CT
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61705-6300
Country	:	US
Telephone Number	:	309-820-8767
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	06/16/2011

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