Provider Demographics
NPI:1619173259
Name:MULLOOLY, BRYAN JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:JAMES
Last Name:MULLOOLY
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 1:6357 CATALINA AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1733
Mailing Address - Country:US
Mailing Address - Phone:708-224-7323
Mailing Address - Fax:
Practice Address - Street 1:4301 WEST MARKHAM STREET
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207
Practice Address - Country:US
Practice Address - Phone:708-224-7323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.126693207L00000X
KYTP118207L00000X
ARE-7613207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology