Basic Information
| Provider Information | |||||||||
| NPI: | 1245226562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULMED | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | NEIL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD FACE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 E 24TH ST | ||||||||
| Address2: | STE 405 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554043840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123365000 | ||||||||
| FaxNumber: | 6127759800 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 E 24TH ST | ||||||||
| Address2: | STE 405 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554043840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123365000 | ||||||||
| FaxNumber: | 6127759800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 20522 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 2128583 | 05 | MN | MEDICAID |