Provider Demographics
NPI:1528023975
Name:MULLEN, CHOLE G (MD)
Entity Type:Individual
Prefix:DR
First Name:CHOLE
Middle Name:G
Last Name:MULLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHOLE
Other - Middle Name:GARIBAY
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1329 E KEMPER RD STE 4212B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-5100
Mailing Address - Country:US
Mailing Address - Phone:513-283-0004
Mailing Address - Fax:513-580-7927
Practice Address - Street 1:1329 E KEMPER RD STE 4212B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-5100
Practice Address - Country:US
Practice Address - Phone:513-283-0004
Practice Address - Fax:513-832-0499
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY301622084P0805X
OH350577022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6037OtherMEDICARE
OH0025661OtherMEDICARE
OH30607030Medicaid
KY0256OtherMEDICARE
OH0798570Medicaid
KY0256OtherMEDICARE