Basic Information
| Provider Information | |||||||||
| NPI: | 1417056730 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULEY | ||||||||
| FirstName: | SURAJ | ||||||||
| MiddleName: | ASHOK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 56765 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900746765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063860 | ||||||||
| FaxNumber: | 6024066132 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 W THOMAS RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024066262 | ||||||||
| FaxNumber: | 6024064606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 01/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 41964 | AZ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 1027885 | 01 | PREFERREDONE | OTHER | 05-00156 | 01 | MEDICA CHOICE | OTHER | 160790 | 01 | UCARE | OTHER | 34048400 | 05 | WI | MEDICAID | 05-00009 | 01 | MEDICA PRIMARY | OTHER | 070A2MU | 01 | MN | BLUECROSS BLUESHIELD | OTHER | HP33188 | 01 | HEALTHPARTNERS | OTHER | 1245756 | 01 | ARAZ | OTHER | 702603000 | 05 | MN | MEDICAID | 0536235 | 05 | IA | MEDICAID |