Healthcare Provider Details

I. General information

NPI: 1962476580
Provider Name (Legal Business Name): MARY E WUNDERLE-MCINTOSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY E WUNDERLE

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E WARWICK DR
ALMA MI
48801-1014
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 989-629-8140
  • Fax: 989-629-8145
Mailing address:
  • Phone: 989-839-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD29024
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301074863
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: