Provider Demographics
NPI:1659320398
Name:MULLIGAN, KATHLEEN A (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:MULLIGAN
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 1:1991 CROCKER RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6969
Mailing Address - Country:US
Mailing Address - Phone:440-617-9114
Mailing Address - Fax:440-617-9058
Practice Address - Street 1:1991 CROCKER RD
Practice Address - Street 2:SUITE 310
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6969
Practice Address - Country:US
Practice Address - Phone:440-617-9114
Practice Address - Fax:440-617-9058
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066003207N00000X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000254178OtherANTHEM BC/BS
OH070017696OtherRAILROAD
OH0839961Medicaid
OH0839961Medicaid
OH070017696OtherRAILROAD