Provider Demographics
NPI:1821081365
Name:MULLENDORE, SEAN (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MULLENDORE
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:PO BOX 642117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-8117
Mailing Address - Country:US
Mailing Address - Phone:402-717-4377
Mailing Address - Fax:402-717-4317
Practice Address - Street 1:3308 SAMSON WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-3194
Practice Address - Country:US
Practice Address - Phone:402-827-1577
Practice Address - Fax:402-898-3134
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21562207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine