Provider Demographics
NPI:1891846911
Name:MULLA, IRENA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENA
Middle Name:
Last Name:MULLA
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 1:4700 N MARINE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7972
Mailing Address - Country:US
Mailing Address - Phone:773-564-5355
Mailing Address - Fax:773-564-5359
Practice Address - Street 1:4700 N MARINE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7972
Practice Address - Country:US
Practice Address - Phone:773-564-5355
Practice Address - Fax:773-564-5359
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118635207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism