Provider Demographics
NPI:1356504427
Name:MARY SHORT-RAY D.O., P.C.
Entity Type:Organization
Organization Name:MARY SHORT-RAY D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-904-2496
Mailing Address - Street 1:180 LITTLE LAKE DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103
Mailing Address - Country:US
Mailing Address - Phone:734-904-2496
Mailing Address - Fax:248-363-1393
Practice Address - Street 1:180 LITTLE LAKE DR
Practice Address - Street 2:SUITE 5
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6219
Practice Address - Country:US
Practice Address - Phone:734-904-2496
Practice Address - Fax:248-363-1393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011718261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care