Provider Demographics
NPI:1073511028
Name:WERKMAN, MARY ANNE (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:WERKMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3955 PATIENT CARE WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4299
Mailing Address - Country:US
Mailing Address - Phone:517-374-7600
Mailing Address - Fax:517-374-1126
Practice Address - Street 1:3955 PATIENT CARE WAY
Practice Address - Street 2:SUITE A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4299
Practice Address - Country:US
Practice Address - Phone:517-374-7600
Practice Address - Fax:517-374-1126
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMW008159207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE26434Medicare UPIN