Individual
MICHAEL R. MCMULLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, DIVISION OF CARDIOLOGY, JACKSON, MS 39216-4500
(601) 984-6426
(601) 984-6439
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5640
(601) 984-6439
Taxonomy
Speciality
Code
Description
License number
State
207RA0002X
Adult Congenital Heart Disease Physician
13195
MS
207RC0000X
Cardiovascular Disease Physician
13195
MS
207RI0011X
Interventional Cardiology Physician
Primary
13195
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0119549
—
MS
01
—
P01402426
RR MEDICARE
MS
Enumeration date
07/06/2006
Last updated
01/24/2019
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