Provider Demographics
NPI:1245226562
Name:MULMED, LAWRENCE NEIL (MD FACE)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:NEIL
Last Name:MULMED
Suffix:
Gender:M
Credentials:MD FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 E 24TH ST
Mailing Address - Street 2:STE 405
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3840
Mailing Address - Country:US
Mailing Address - Phone:612-336-5000
Mailing Address - Fax:612-775-9800
Practice Address - Street 1:710 E 24TH ST
Practice Address - Street 2:STE 405
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3840
Practice Address - Country:US
Practice Address - Phone:612-336-5000
Practice Address - Fax:612-775-9800
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20522207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2128583Medicaid
460000008Medicare ID - Type Unspecified
D81566Medicare UPIN