1699119412 NPI number — DR. RONALD DEAN MULDER M.D.

Table of content: DR. RONALD DEAN MULDER M.D. (NPI 1699119412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699119412 NPI number — DR. RONALD DEAN MULDER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULDER
Provider First Name:
RONALD
Provider Middle Name:
DEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULDER
Provider Other First Name:
RONALD
Provider Other Middle Name:
DEAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1699119412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17236 SANDGATE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST OLIVE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49460-8508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-296-9222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17236 SANDGATE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST OLIVE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49460-8508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-296-9222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  4301028719 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)