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NPI Code Detail

MEDICARE: TIFFANY MULLEN DO

MEDICARE: TIFFANY MULLEN DO
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
1207Q00000XFamily Medicine Physician47814WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00784994OTHERWIRR MEDICARE

General Provider Information

NPI Number : 1760599187
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY MULLEN DO
Provider Business Mailing Address
First Line : 3003 W. GOOD HOPE ROAD
Second Line :
City : MILWAUKEE
State : WI
Zip : 53209
Country : US
Telephone Number : 414-352-3100
Fax Number :
Provider Business Practice Location Address
First Line : 325 E. SILVER SPRING DRIVE
Second Line :
City : WHITEFISH BAY
State : WI
Zip : 53217-5222
Country : US
Telephone Number : 414-247-4800
Fax Number : 414-247-4801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 01/18/2011

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