Basic Information
| Provider Information | |||||||||
| NPI: | 1629154356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULDOON | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | PHILLIP | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2050 PFINGSTEN RD STE 128 | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600261324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475701700 | ||||||||
| FaxNumber: | 8475034313 | ||||||||
| Practice Location | |||||||||
| Address1: | 2050 PFINGSTEN RD STE 128 | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475701700 | ||||||||
| FaxNumber: | 8475034313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 036084261 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | 036084261 | IL | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.