Provider Demographics
NPI:1659395572
Name:MULLEN, JULIE A (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:MULLEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 W LAKESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2108
Mailing Address - Country:US
Mailing Address - Phone:859-426-7359
Mailing Address - Fax:
Practice Address - Street 1:935 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1911
Practice Address - Country:US
Practice Address - Phone:513-831-5955
Practice Address - Fax:513-831-5985
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6786207Q00000X
KY02675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG63968Medicare UPIN
OHMU4093094Medicare ID - Type UnspecifiedMILFORD MEDICARE #
OHMU4093098Medicare UPIN
KY0793813Medicare ID - Type UnspecifiedERLANGER MEDICARE #
OHMU4093095Medicare ID - Type UnspecifiedCOLERAIN MEDICARE #
OHMU4093096Medicare ID - Type UnspecifiedDAYTON MEDICARE #
OHMU4093098Medicare UPIN
KY0793813Medicare ID - Type UnspecifiedERLANGER MEDICARE #
OHMU4093094Medicare ID - Type UnspecifiedMILFORD MEDICARE #