Individual
TIMOTHY JAMES MULLALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
11275 DELAWARE PKWY, CROWN POINT, IN 46307-7812
(219) 779-8735
(877) 715-2312
Mailing address
PO BOX 108, CROWN POINT, IN 46308-0108
(219) 779-8735
(877) 715-2312
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02003099A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
02003099A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200829740
—
IN
Enumeration date
07/19/2006
Last updated
03/25/2019
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