Individual
MS. KIMBERLY ANN MULLIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2025 S CHICAGO ST, JOLIET, IL 60436
(815) 726-2200
(314) 536-8783
Mailing address
1800 N MAIN ST, WHEATON, IL 60187-3112
(630) 614-4960
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003958
IL
363A00000X
Physician Assistant
3711
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
525200005
MEDICARE PTAN
IL
Enumeration date
10/04/2007
Last updated
06/18/2018
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