Provider Demographics
NPI:1326271354
Name:MULHALL, BRANDON M
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:M
Last Name:MULHALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 BURTON TRL
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-2336
Mailing Address - Country:US
Mailing Address - Phone:217-416-3554
Mailing Address - Fax:
Practice Address - Street 1:3807 BURTON TRL
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-2336
Practice Address - Country:US
Practice Address - Phone:217-416-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies