Basic Information
| Provider Information | |||||||||
| NPI: | 1871597518 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULLINS, JR | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ERIC | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 N ORANGE BLOSSOM TRL STE 300 | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347442308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078467200 | ||||||||
| FaxNumber: | 4078463989 | ||||||||
| Practice Location | |||||||||
| Address1: | 25080 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481241740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137308880 | ||||||||
| FaxNumber: | 3137301167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | JM068606 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 4223111 | 05 | MI | MEDICAID | 160050107 | 01 | MI | MEDICARE RAILROAD | OTHER |