Provider Demographics
NPI:1689785321
Name:MULCAHY, AMY KRISTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KRISTIN
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 S LAKE PARK AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6790
Mailing Address - Country:US
Mailing Address - Phone:219-942-6166
Mailing Address - Fax:216-942-4106
Practice Address - Street 1:1400 S LAKE PARK AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6790
Practice Address - Country:US
Practice Address - Phone:219-942-6166
Practice Address - Fax:216-942-4106
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN10000660A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q31579Medicare UPIN