Provider Demographics
NPI:1568421543
Name:MULLIN, PETER G (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:MULLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 S IOWA ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1900
Mailing Address - Country:US
Mailing Address - Phone:608-935-3301
Mailing Address - Fax:608-935-1149
Practice Address - Street 1:833 S IOWA ST STE 102
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1900
Practice Address - Country:US
Practice Address - Phone:608-935-3301
Practice Address - Fax:608-935-1149
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1568421543Medicaid
WIK400176509Medicare PIN
WIP01504475Medicare PIN
WI60690OtherDEAN HEALTH INSURANCE
WI011857155Medicare PIN