Provider Demographics
NPI:1134487804
Name:MIER, MARY LEE (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LEE
Last Name:MIER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3440 CHICAGO DR STE 105
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-1419
Mailing Address - Country:US
Mailing Address - Phone:616-796-9560
Mailing Address - Fax:
Practice Address - Street 1:3440 CHICAGO DR STE 105
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-1419
Practice Address - Country:US
Practice Address - Phone:616-796-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101028273207Q00000X
OH34.015838207Q00000X
GA076143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine