Provider Demographics
NPI:1124201900
Name:JOHN MULLEN MD PS
Entity Type:Organization
Organization Name:JOHN MULLEN MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEELE
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-292-6488
Mailing Address - Street 1:1221 MADISON ST #1210
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1356
Mailing Address - Country:US
Mailing Address - Phone:206-292-6488
Mailing Address - Fax:206-623-2436
Practice Address - Street 1:1221 MADISON ST #1210
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1356
Practice Address - Country:US
Practice Address - Phone:206-292-6488
Practice Address - Fax:206-623-2436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1117910Medicaid
WADF1382OtherMEDICARE RAILROAD
WAG8852862Medicare PIN