Provider Demographics
NPI:1972609683
Name:THORNE, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:THORNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 CHARTWELL CARRIAGE WAY NORTH
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2404
Mailing Address - Country:US
Mailing Address - Phone:517-337-2030
Mailing Address - Fax:517-337-2030
Practice Address - Street 1:1280 CHARTWELL CARRIAGE WAY NORTH
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2404
Practice Address - Country:US
Practice Address - Phone:517-337-2030
Practice Address - Fax:517-337-2030
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0803306961OtherBCBS INDIVIDUAL PIN
MI2753674Medicaid
MI0C36170005Medicare ID - Type Unspecified
MI0803306961OtherBCBS INDIVIDUAL PIN