Provider Demographics
NPI:1972587806
Name:FERRIS, MARY C (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:FERRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4845 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6442
Mailing Address - Country:US
Mailing Address - Phone:586-977-5780
Mailing Address - Fax:586-977-0391
Practice Address - Street 1:4845 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6442
Practice Address - Country:US
Practice Address - Phone:586-977-5780
Practice Address - Fax:586-977-0391
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1972587806Medicaid
MI700H217350OtherBLUE SHIELD
MI121172OtherCARE-PREFERRED CHOICES
MIE26356Medicare UPIN
MI121172OtherCARE-PREFERRED CHOICES