Provider Demographics
NPI:1508826678
Name:MULLIGAN, KATHRYN H (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:H
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:757 45TH AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2911
Mailing Address - Country:US
Mailing Address - Phone:219-934-2461
Mailing Address - Fax:219-934-2478
Practice Address - Street 1:919 MAIN ST
Practice Address - Street 2:STE 102
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-3717
Practice Address - Country:US
Practice Address - Phone:219-934-2492
Practice Address - Fax:219-934-2493
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01052342207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200301400Medicaid
IN200301400Medicaid
IN499500 LLMedicare PIN