Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | G62916 | CA |
NPI | 1306884283 |
---|---|
Provider Name | Michael Joseph Mulligan |
First Address | Mountain View, CA 94040-6201 |
Second Address | Mountain View, CA 94040-2833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 07/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F11765 | (02) | CA |