Individual
CHARLES N. MULLICAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
711 N 36TH ST, SAINT JOSEPH, MO 64506-2977
(816) 271-7190
(816) 271-7672
Mailing address
711 N 36TH ST, SAINT JOSEPH, MO 64506-2977
(816) 271-7190
(816) 271-7672
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2010020683
MO
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
2010020683
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080111091
RR MEDICARE
MO
05
—
1275847642
—
MO
Enumeration date
07/28/2010
Last updated
07/21/2022
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