1528023975 NPI number — DR. CHOLE G MULLEN MD

Table of content: DR. CHOLE G MULLEN MD (NPI 1528023975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528023975 NPI number — DR. CHOLE G MULLEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLEN
Provider First Name:
CHOLE
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULLEN
Provider Other First Name:
CHOLE
Provider Other Middle Name:
GARIBAY
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:
1528023975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1329 E KEMPER RD STE 4212B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45246-5100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-283-0004
Provider Business Mailing Address Fax Number:
513-580-7927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1329 E KEMPER RD STE 4212B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45246-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-283-0004
Provider Business Practice Location Address Fax Number:
513-832-0499
Provider Enumeration Date:
04/19/2006

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: 2084P0805X , with the licence number:  30162 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 35057702 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6037 . This is a "MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0025661 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 30607030 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0256 . This is a "MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0798570 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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