Provider Demographics
NPI:1659595775
Name:MULRENIN, STEVEN V (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:V
Last Name:MULRENIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14148 PATTERSON DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4263
Mailing Address - Country:US
Mailing Address - Phone:586-774-7800
Mailing Address - Fax:586-771-0730
Practice Address - Street 1:24725 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-4500
Practice Address - Country:US
Practice Address - Phone:586-774-7800
Practice Address - Fax:586-771-0730
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
970N14040Medicare ID - Type Unspecified
P23693Medicare UPIN