Basic Information
| Provider Information | |||||||||
| NPI: | 1982677944 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULROONEY | ||||||||
| FirstName: | KARIN | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | N17 W24100 RIVERWOOD DRIVE SUITE 250 | ||||||||
| Address2: | WAUKESHA HEALTH CARE INC. | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531881177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629284100 | ||||||||
| FaxNumber: | 2629285835 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 MAPLE AVENUE | ||||||||
| Address2: | PROHEALTH CARE MEDICAL CENTERS-MUKWONAGO | ||||||||
| City: | MUKWONAGO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629281900 | ||||||||
| FaxNumber: | 2623631949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 03/13/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 39118 | WI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 32531700 | 05 | WI | MEDICAID |