Provider Demographics
NPI:1760412746
Name:MULSHINE, PAMELA M (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:M
Last Name:MULSHINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1337
Mailing Address - Country:US
Mailing Address - Phone:708-488-0434
Mailing Address - Fax:
Practice Address - Street 1:907 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1337
Practice Address - Country:US
Practice Address - Phone:708-488-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115325Medicaid
IL036115325Medicaid