Provider Demographics
NPI:1104805076
Name:MULHOLLAND, DAN M (MD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:M
Last Name:MULHOLLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:319-287-9249
Practice Address - Street 1:312 9TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2929
Practice Address - Country:US
Practice Address - Phone:319-235-5390
Practice Address - Fax:319-233-1630
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA247492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
421417307L6OtherJOHN DEERE HEALTH CARE
IA0725309Medicaid
IA25741OtherWELLMARK HEALTH CARE
421417307L6OtherJOHN DEERE HEALTH CARE
IAI17905Medicare PIN