Provider Demographics
NPI:1417037755
Name:MULAWKA, JOHN M III (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:MULAWKA
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6763 ERIE ROAD RT 5
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047
Mailing Address - Country:US
Mailing Address - Phone:716-947-2222
Mailing Address - Fax:716-947-2223
Practice Address - Street 1:6763 ERIE ROAD RT 5
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047
Practice Address - Country:US
Practice Address - Phone:716-947-2222
Practice Address - Fax:716-947-2223
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224453208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02282048Medicaid
NY02282048Medicaid