Provider Demographics
NPI:1689637878
Name:MULDERIG, JAMES KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KEVIN
Last Name:MULDERIG
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 1:3002 AMBLER DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-3100
Mailing Address - Country:US
Mailing Address - Phone:513-207-0139
Mailing Address - Fax:513-522-2041
Practice Address - Street 1:3002 AMBLER DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-3100
Practice Address - Country:US
Practice Address - Phone:513-207-0139
Practice Address - Fax:513-522-2041
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301138592084P0800X
OH350547242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0845527Medicaid
MU0665411Medicare ID - Type Unspecified
OH0845527Medicaid
IN200398550AMedicare PIN