Provider Demographics
NPI:1760617500
Name:MULLIGAN DERMATOLOGY, INC
Entity Type:Organization
Organization Name:MULLIGAN DERMATOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ESSI
Authorized Official - Suffix:
Authorized Official - Credentials:LPA
Authorized Official - Phone:440-899-2300
Mailing Address - Street 1:1991 CROCKER RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6969
Mailing Address - Country:US
Mailing Address - Phone:440-899-2300
Mailing Address - Fax:440-617-9058
Practice Address - Street 1:1991 CROCKER RD
Practice Address - Street 2:SUITE 310
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6969
Practice Address - Country:US
Practice Address - Phone:440-899-2300
Practice Address - Fax:440-617-9058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3566003207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty