Provider Demographics
NPI:1912906462
Name:MULLICK, TARUN (MD)
Entity Type:Individual
Prefix:DR
First Name:TARUN
Middle Name:
Last Name:MULLICK
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 1:2631 WILLIAMSBURG AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1101
Mailing Address - Country:US
Mailing Address - Phone:630-232-2025
Mailing Address - Fax:630-232-2780
Practice Address - Street 1:485 S DOBSON RD STE 101
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5603
Practice Address - Country:US
Practice Address - Phone:480-728-4981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.143072207RG0100X
IL036108726174400000X
MI4301502257207RG0100X
AZ58745207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108726Medicaid
IL04532244OtherBLUE CROSS BLUE SHIELD
ILP00197568OtherRAILROAD MEDICARE
IL036108726Medicaid
ILP00197568OtherRAILROAD MEDICARE
IL04532244OtherBLUE CROSS BLUE SHIELD