Provider Demographics
NPI:1144526740
Name:MULU, MENELIK (MD)
Entity type:Individual
Prefix:DR
First Name:MENELIK
Middle Name:
Last Name:MULU
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 1:2925 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-7915
Mailing Address - Country:US
Mailing Address - Phone:660-829-5852
Mailing Address - Fax:660-829-5854
Practice Address - Street 1:2925 CLINTON RD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-7915
Practice Address - Country:US
Practice Address - Phone:660-829-5852
Practice Address - Fax:660-829-5854
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011021987208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program