Provider Demographics
NPI:1629154356
Name:MULDOON, JOSEPH PHILLIP (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PHILLIP
Last Name:MULDOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2050 PFINGSTEN RD STE 128
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1324
Mailing Address - Country:US
Mailing Address - Phone:847-570-1700
Mailing Address - Fax:847-503-4313
Practice Address - Street 1:2050 PFINGSTEN RD STE 128
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026
Practice Address - Country:US
Practice Address - Phone:847-570-1700
Practice Address - Fax:847-503-4313
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084261208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG54846Medicare UPIN