Provider Demographics
NPI:1710007125
Name:KOWALCZYK MULLINS, TANYA L (MD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:L
Last Name:KOWALCZYK MULLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:L
Other - Last Name:KOWALCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 4000
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4681
Mailing Address - Fax:513-636-8844
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 4000
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4681
Practice Address - Fax:513-636-8844
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.0091182080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine