MEDICARE: MARY D HUNT D O PLLC

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	207Q00000X	Family Medicine Physician	5101010433	MI

General Provider Information

NPI Number	:	1831361211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY D HUNT D O PLLC

Provider Business Mailing Address
First Line	:	221 W LAKE LANSING RD
Second Line	:	STE 300
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8661
Country	:	US
Telephone Number	:	517-332-3980
Fax Number	:	517-332-3983

Provider Business Practice Location Address
First Line	:	221 W LAKE LANSING RD
Second Line	:	STE 300
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8661
Country	:	US
Telephone Number	:	517-332-3980
Fax Number	:	517-332-3983

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	MRS. MARY DAWSON HUNT
Credential	:	D.O.
Telephone Number	:	517-332-3980

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	04/22/2009

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