Provider Demographics
NPI:1609589506
Name:MULHOLLAND, CALEB BENJAMIN
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:BENJAMIN
Last Name:MULHOLLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RED BALL TRL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-2781
Mailing Address - Country:US
Mailing Address - Phone:618-664-1240
Mailing Address - Fax:618-690-2189
Practice Address - Street 1:1000 RED BALL TRL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-2781
Practice Address - Country:US
Practice Address - Phone:618-664-1240
Practice Address - Fax:618-690-2189
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant