Provider Demographics
NPI:1356428148
Name:MULDOON, MICHAEL P (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:MULDOON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3750 CONVOY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3738
Mailing Address - Country:US
Mailing Address - Phone:858-278-8300
Mailing Address - Fax:858-278-1708
Practice Address - Street 1:3750 CONVOY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3738
Practice Address - Country:US
Practice Address - Phone:858-278-8300
Practice Address - Fax:858-278-1708
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG70877207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G708770Medicaid
CA00G708770Medicaid
CAWG70877BMedicare ID - Type Unspecified