Provider Demographics
NPI:1831361211
Name:MARY D HUNT D O PLLC
Entity type:Organization
Organization Name:MARY D HUNT D O PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DAWSON
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-332-3980
Mailing Address - Street 1:221 W LAKE LANSING RD
Mailing Address - Street 2:STE 300
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8661
Mailing Address - Country:US
Mailing Address - Phone:517-332-3980
Mailing Address - Fax:517-332-3983
Practice Address - Street 1:221 W LAKE LANSING RD
Practice Address - Street 2:STE 300
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8661
Practice Address - Country:US
Practice Address - Phone:517-332-3980
Practice Address - Fax:517-332-3983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE37314Medicare UPIN