Deland Maurice McMullan Jr.

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1258592 Issued in MI

Practice address

1122 Walnut St
Ypsilanti, MI 48198-3937

Phone

(734) 320-4819

NPI assigned

Aug 6, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shane Fitness LLC

  • Athletic Trainer
  • Ypsilanti, MI
  • NPI 1871108563
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596672000000",
    "number": "1295345056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970646",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481970088",
            "telephone_number": "734-320-4819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 WALNUT ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481983937",
            "telephone_number": "734-320-4819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMULLAN",
        "first_name": "DELAND",
        "middle_name": "MAURICE",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-06",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "1258592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Marie McKowell, FNP-BC
• Rachel Joanne McLaughlin, MD
• Crystal Chiffon McLilley, RN
• Louise McMaster, P.T
• Antonio McMillian
• Daniel George McMurtrie, M.D.
• Patricia McNally, MD
• B. Melanie McNicholas, CRNA
• Brittany McQueer, MPH
• Ruth McRae

• Athletic Trainer in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.