Provider Demographics
NPI:1043517006
Name:MULLINS, NATHAN CRAIG (DO)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:CRAIG
Last Name:MULLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-839-3000
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-3861
Practice Address - Country:US
Practice Address - Phone:216-839-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-26
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-2377-202085R0202X
CO588912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO582053YQ33OtherMEDICARE
CO582053YQN9OtherMEDICARE
NENA1214121OtherMEDICARE PIN
CO582053YQPGOtherMEDICARE
CO582053ZNTBOtherMEDICARE
KSKA3249100OtherMEDICARE PIN
NENA2517099OtherMEDICARE PIN
CO1043517006Medicaid
KS111257109OtherMEDICARE PIN
CO582053ZLJ3OtherMEDICARE