Provider Demographics
NPI:1801895941
Name:MULLIN, ROBERT (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MULLIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 CAMPUS DR
Mailing Address - Street 2:SUITE 325
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2676
Mailing Address - Country:US
Mailing Address - Phone:763-550-1013
Mailing Address - Fax:763-550-0615
Practice Address - Street 1:2805 CAMPUS DR
Practice Address - Street 2:SUITE 325
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2676
Practice Address - Country:US
Practice Address - Phone:763-550-1013
Practice Address - Fax:763-550-0615
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN507213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN884525500Medicaid
U42066Medicare UPIN
MN884525500Medicaid