Provider Demographics
NPI:1700825536
Name:MULLIKEN, JOHN B (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:MULLIKEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:HU-158
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-7384
Mailing Address - Fax:617-738-1657
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:CHILDRENS HOSPITAL DIVISION OF PLASTIC SURGERY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-7686
Practice Address - Fax:617-738-1657
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-06-17
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Provider Licenses
StateLicense IDTaxonomies
MA29642208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2022958Medicaid
MA2022958Medicaid
M08661Medicare ID - Type Unspecified