Individual
GINA MARIE MULLOOLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
W223S6915 ALAMEDA DR, BIG BEND, WI 53103-9440
(608) 628-4807
Mailing address
W223S6915 ALAMEDA DR, BIG BEND, WI 53103-9440
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
55931-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/13/2009
Last updated
07/03/2013
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