Provider Demographics
NPI:1528190519
Name:MULKA, LINDA LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LOUISE
Last Name:MULKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 WINDWALKER RD
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-8507
Mailing Address - Country:US
Mailing Address - Phone:719-395-5686
Mailing Address - Fax:
Practice Address - Street 1:129 WINDWALKER RD
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-8507
Practice Address - Country:US
Practice Address - Phone:719-395-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25473207Q00000X
NM84-230207Q00000X
MI40439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine