Provider Demographics
NPI:1164860086
Name:MULLALLY, ANDREW J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:MULLALLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10050 AUBURN PARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2389
Mailing Address - Country:US
Mailing Address - Phone:260-432-6459
Mailing Address - Fax:260-240-5284
Practice Address - Street 1:10050 AUBURN PARK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2389
Practice Address - Country:US
Practice Address - Phone:260-432-6459
Practice Address - Fax:260-240-5284
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2017-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01074259A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine