Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036102055 | IL |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 036102055 | IL |
NPI | 1891773925 |
---|---|
Provider Name | Barry T Mulshine |
First Address | Springfield, IL 62791-9469 |
Second Address | Springfield, IL 62711-9252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 13/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036102055 | (05) | IL |
200038220 | RR MEDICARE (01) | IL |