Provider Demographics
NPI:1881099661
Name:PADALINO, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PADALINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35640 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1628
Mailing Address - Country:US
Mailing Address - Phone:734-729-7792
Mailing Address - Fax:
Practice Address - Street 1:20955 BOURNEMOUTH ST
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-2301
Practice Address - Country:US
Practice Address - Phone:313-423-6106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIP345587461969247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other