Individual
DR. MICHAEL RUSSELL MULLANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1900 W POLK ST, ROOM 765, CHICAGO, IL 60612-3723
(312) 864-7194
(312) 864-9002
Mailing address
374 BARTRAM RD, RIVERSIDE, IL 60546-1885
(312) 864-7194
(312) 864-9002
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-068847
IL
207RX0202X
Medical Oncology Physician
Primary
036-068847
IL
Other
Enumeration date
07/21/2006
Last updated
04/27/2021
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