Individual
JOSEPH MICHAEL MULLIGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
515 LAKE FRONT RD., LEITCHFIELD, KY 42754
(270) 230-0377
Mailing address
515 LAKE FRONT RD., LEITCHFIELD, KY 42754
(270) 230-0377
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28092549A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10001010
—
IN
01
—
360955
IN BCBS ANTHEM PROVIDER #
IN
Enumeration date
06/01/2006
Last updated
08/07/2007
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