Provider Demographics
NPI:1386657005
Name:HUGHES, MARY J (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:J
Last Name:HUGHES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FEE RD # B311
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-6537
Mailing Address - Country:US
Mailing Address - Phone:517-353-3211
Mailing Address - Fax:
Practice Address - Street 1:401 W GREENLAWN
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-975-7509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008186207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0153310415OtherBLUE CROSS BLUE SHIELD
MI2757163Medicaid
MI200000002138OtherPHP & PHPFC
MIC37626006Medicare PIN
C37612010Medicare PIN
MI2757163Medicaid