MEDICARE: DR. MARY KEATING OCALLAGHAN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	5101009391	MI

General Provider Information

NPI Number	:	1558369884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY KEATING OCALLAGHAN DO

Provider Business Mailing Address
First Line	:	889 N JEBAVY DR
Second Line	:
City	:	LUDINGTON
State	:	MI
Zip	:	49431-1208
Country	:	US
Telephone Number	:	231-510-6877
Fax Number	:

Provider Business Practice Location Address
First Line	:	889 N JEBAVY DR
Second Line	:
City	:	LUDINGTON
State	:	MI
Zip	:	49431-1208
Country	:	US
Telephone Number	:	231-510-6877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/14/2020

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