Provider Demographics
NPI:1659864387
Name:LACOURSIERE, MARY REGINA FEEKS (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:REGINA FEEKS
Last Name:LACOURSIERE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-2129
Mailing Address - Fax:
Practice Address - Street 1:615 N MICHIGAN ST 5TH FL
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1033
Practice Address - Country:US
Practice Address - Phone:574-647-7275
Practice Address - Fax:574-647-3696
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2024-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02007852A2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300093262Medicaid