Provider Demographics
NPI:1326058975
Name:MUHLENDORF, IVAN KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:KENNETH
Last Name:MUHLENDORF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:844 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3927
Mailing Address - Country:US
Mailing Address - Phone:757-461-6131
Mailing Address - Fax:757-461-3897
Practice Address - Street 1:844 KEMPSVILLE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3927
Practice Address - Country:US
Practice Address - Phone:757-461-6131
Practice Address - Fax:757-461-3897
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028126207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160001339Medicare PIN
VAD75232Medicare UPIN