| J Mullally Md Pllc | |
|
1117 Stone St Suite 2 Port Huron MI 48060-3525 | |
| (810) 966-4540 | |
| Not Available |
| Full Name | J Mullally Md Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1117 Stone St, Port Huron, Michigan |
| Authorized Official Name and Position | Beth A Noble (OFFICE MANAGER) |
| Authorized Official Contact | 8109664540 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J Mullally Md Pllc 1117 Stone St Suite 2 Port Huron MI 48060-3525 Ph: (810) 966-4540 | J Mullally Md Pllc 1117 Stone St Suite 2 Port Huron MI 48060-3525 Ph: (810) 966-4540 |
| NPI Number | 1699084889 |
|---|---|
| Provider Enumeration Date | 10/05/2010 |
| Last Update Date | 10/05/2010 |
| Medicare PECOS PAC ID | 6800088576 |
|---|---|
| Medicare Enrollment ID | O20101013000623 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699084889 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | John Patrick Mullally |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033105630 PECOS PAC ID: 7618169384 Enrollment ID: I20101013000748 |
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