Provider Demographics
NPI:1497724678
Name:MULDER, JOEL R (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:R
Last Name:MULDER
Suffix:
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:1 WALTER SCHOLER DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-6303
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66015207Q00000X
IN02002514A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200399900Medicaid
IN000000991570OtherBCBS MED POINT MAIN ST
IN11438171OtherCAQH NUMBER
IN000000991565OtherBCBS PORTAGE AVE
IN000000349906OtherANTHEM PROVIDER PIN - FAMILY MEDICINE
IN000000923025OtherANTHEM PROVIDER PIN - URGENT CARE
IN9397339OtherPHCS PID NUMBER
IN000000991565OtherBCBS PORTAGE AVE
IN000000923025OtherANTHEM PROVIDER PIN - URGENT CARE
IN247000003Medicare PIN
IN000000349906OtherANTHEM PROVIDER PIN - FAMILY MEDICINE
IN9397339OtherPHCS PID NUMBER
IN815510WWMedicare PIN
INH75614Medicare UPIN
IN200399900Medicaid
IN815520CCCMedicare PIN
INP00240909Medicare PIN