Individual
KEVIN J MULLANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8100 NORTHLAND DR, BLOOMINGTON, MN 55431-4800
(952) 831-8742
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
45583
MN
207X00000X
Orthopaedic Surgery Physician
45583
MN
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
45583
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
747647700
—
MS
Enumeration date
07/03/2006
Last updated
03/14/2024
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