Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1040 | SD |
NPI | 1821028531 |
---|---|
Provider Name | Scott J. Mullenmeister |
First Address | Mitchell, SD 57301-4116 |
Second Address | Mitchell, SD 57301-4116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 12/12/2011 |