Randall L Mullin, MD
Individual provider Active NPI Family Medicine Physician · Annawan, IL
NPI 1174501332 · NPPES record last updated Jan 15, 2014
Key facts
- NPI
- 1174501332
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 036048491 (IL)
- Practice address
- 110 S Depot St
Annawan, IL 61234-7768 - Phone
- (309) 944-5124
- Fax
- (309) 721-1407
- NPI assigned
- Jan 6, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036048491 | IL | Yes |
Addresses
Primary practice location
110 S Depot St
Annawan, IL 61234-7768
Mailing address
110 S Depot St
Annawan, IL 61234-7768
Phone (309) 944-5124
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174501332 | Medicaid | IL | |
| 036048491 | Medicaid | IL | |
| 0360484912 | Medicaid | IL |
Other providers in Annawan, IL
- Kelli Rae Desplinter
- Hammond Henry Dist Hospital
- Iowa Physicians Clinic Medical Foundation
- Jeffrey Lynn Lathrop
- Rima Mounsef
- Janelle Pillard
- Paul M Rudy
All providers in Annawan, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.